NCC221910_Contact Update Record_20240411

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/11/2024 8:28:03 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC221910
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-1910
Original NOI No.* 91449
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
DR Horton, Inc
Project Name Collybrooke Farm Phases 20
Address NC HWY 65,Stokesdale, NC
County Rockingham
Latitude 36.2716
Longitude -79.9203
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? Q No
4) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 9192156561
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Jessica Meyer
Individual(Previous)
First Name(New)* Neil
Last Name(New)* Uldrick

NEW Legally Reflects any revisions above
Responsible Neil Uldrick
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2000 Aerial Center Parkway,0, Morrisville,
Address(Previous) NC 27560-9294
NEW Permittee Street Address
Mailing Address* 4150 Mendenhall Oaks Parkway
Address Line 2
City State/Province/Region
High Point NC
Postal/Zip Code Country
27265 Us
Permittee Street 2000 Aerial Center Parkway,0, Morrisville,
Address(Previous) NC 27560-9294
NEW Permittee Street Street Address
Address* 4150 Mendenhall Oaks Parkway
Address Line 2
City State/Province/Region
High Point NC
Postal/Zip Code Country
27265 Us
Change Requested Neil Uldrick via Modification Request submitted 4/10/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/11/2024