NCC241284_FRO Submitted_20240507

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Albers Glenshore- Mountain Base,LLC
2. Location of land-disturbing activity: County Jackson City or Township_Hamburg
Highway/Street Glenshore Drive atitude decimal degrees) 35.1;3 Lon itude dep�„ai d 83.158 c s > 9 c es�ees>_
3. Approximate date land-disturbing activity will commence: May 1, 9(124
1. Purpose of development(residential, commercial, industrial, institutional, etc.): Rasirtantial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2,15
6. Amount of fee enclosed: $ . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes❑x Enclosed ❑x No ❑
8 Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Nathan Albers E-mail Address [e-mail]
Phone: Office# Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Mountain Base, LLC 561-723-3003
Name Phone: Office# Mobile#
P.O. Box 1909 942 Pompano Drive
Current Mailing Address Current Street Address
Jupiter, FL 33468 Jupiter, FL 33458
City State Zip City State Zip
10. Deed Book No.2361 Page No. 1 763 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s). the name(s)of the owner(s)may be listed as the financially responsible party(ies).
Mountain Base, LLC [e-mail]
Company Name E-mail Address
P.O. Box 1909 942 Pompano Drive
Current Mailing Address Current Street Address
Jupiter, FL 33468 Jupiter, FL 33458
City State Zip City State Zip
Phone: Office# Mobile# [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Kimberly R. Coward [e-mail]
Name of Registered Agent E-mail Address
11 Cashiers School Road
Current Mailing Address Current Street Address
Cashiers NC 28717
City State Zip City State Zip
Phone: Office# Mobile# [phone]
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Mountain Base, LLC
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
Nathan Albers CEO
Type or print name Title or Authority
Oe/ 4/22/24
Signature Date
• I l
�Q C , a Notary Public of the County of n 1 Pr"---1 / I1
State of Vi L Ya, hereby certify that I ZC �c1 \ �—�1 `D�,�S appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this day of \arf 1 , 20 7 L-1
UOWNIC—e
Notary
My commission expires CC 4-0-Dse ✓ �� DO
$���`°� sHERI VANCE
"1( r MY COMMISSION#HH193008
\ ,,,/EXPIRES:October 31,2025

Page 1 of 3
Type: WARRANTY DEED
Recorded: 8/17/2023 3:58:15 PM
Fee Amt: $1,926.00 Page 1 of 3
Revenue Tax: $1,900.00
Jackson County, NC
Shandra Sims Register of Deeds
BK 2361 PG 1763 - 1765
-y,CTC j0
, 1 L
Aug - 17 2023 CC
This instrument prepared by:
Kimberly R. Coward, a licensed
North Carolina Attorney
Coward, Hicks & Sider, P.A.
Post Office Box 1918
Cashiers, NC 28717
Delinquent taxes, if any, to be paid by the closing attorney to the county tax collector upon
disbursement of closing proceeds.
Rev. $1,900.00; improved; not primary residence
PIN: 7554-73-8679—Tract A; whole transfer
7554-84-1210—Tract B; whole transfer
STATE OF NORTH CAROLINA
COUNTY OF JACKSON
WARRANTY DEED
THIS WARRANTY DEED is made this 1 day of August, 2023, by and between RSJ
REAL ESTATE, L.L.C., an Ohio limited liability company, of 600 Gillam Road, Wilmington,
OH 45177, hereinafter referred to as "Grantor," and MOUNTAIN BASE, LLC, a North
Carolina limited liability company, of P. O. Box 1909, Jupiter, FL 33468-1909, hereinafter
referred to as "Grantee." The terms grantor and grantee shall be used as neuter singular
designation of the parties hereto,their personal representatives, heirs, successors and assigns.
WITNES SETH:
That the Grantor, for a valuable consideration paid by the Grantee,the receipt of which is
hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the
Grantee in fee simple, all that certain lot or parcel of land situated in Hamburg Township,
Jackson County,North Carolina, and more particularly described as follows:
1
submitted electronically by "Coward Hicks & slier"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Jackson County Register of Deeds.
Book: 2361 Page: 1763 Seq: 1

Page 2 of 3
BEING ALL of Tract A, containing 23.12 acres, and Tract B, containing 4.21 acres, as
shown on a plat thereof prepared by W. Edward Hall, L.S., dated April 3, 2020, and
recorded in Plat Cabinet 23, Slide 815, Jackson County Registry, to which reference is
specifically made.
SUBJECT TO the sixty (60') foot right-of-way of North Carolina State Road 1154
(Lloyd Hooper Road) as shown on the above-referenced plat.
SUBJECT TO the right-of-way of"GLENSHORE DRIVE—PRIVATE—60' R/W" as
shown on the above-referenced plat and as set forth more particularly in the Right-of-
Way Deeds recorded in Book 506, Page 645, Book 366, Page 527, and Book 366, Page
531, Jackson County Registry, to which reference is specifically made, and the deed
recorded in Book 366, Page 541, Jackson County Registry, to which reference is
specifically made, and SUBJECT TO the maintenance duties set forth therein.
SUBJECT TO the utility easements described in the Easements/Right-of-Way
Agreements recorded in Book 529, Page 191, Book 391, Page 438, and Book 912, Page
685, Jackson County Registry,to which reference is specifically made.
For source of title, see the deed recorded in Book 2266, Page 976, Jackson County
Registry, to which reference is specifically made.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances thereto belonging to the Grantee in fee simple, subject to the reservations,
exceptions and limitations contained herein.
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee
simple, has the right to convey the same in fee simple,that title is marketable and free and clear
of all encumbrances, and that Grantor,will warrant and defend the title against the lawful claims
of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is conveyed subject to the following
exceptions:
Exceptions and reservations contained in this deed and/or in instruments referenced
herein.
Easements and rights-of-way for public and private roads and utilities, of public record.
Lien of ad valorem taxes for the current year and subsequent years, not yet due and
payable.
2
Book: 2361 Page: 1763 Seq: 2

Page 3 of 3
IN WITNESS WHEREOF, Grantor has caused these presents to be executed by its
Manager on behalf of said limited liability company,the day and year first above-written.
RSJ REAL ESTATE,L.L.C., an Ohio limited
liability company
By:
DO ALD R.DeL C ,Vice President,Legal
STATE OF
COUNTY OF i
I, a Notary Public of a r% "f ounty eaaforesaid, do
hereby certify that DONALD R.DeLUCA,Vice President,Legal of RSJ REAL
ESTATE,L.L.C., an Ohio limited liability company, ersonally appeared before
me this day and acknowledged the due execution of the foregoing instrument on
behalf of said limited liability company.
WITNESS my hand and official stamp or seal,this the t day of August,2023.
\i a.,..__pi
(OFFICIAL SEAL)
.C� va� JEANNE HAGAN 1 •�� '_ Notary Public-State of Florida i Notary Public
_'�" �"o" Commission�HH 224625 •
4 "'•''.? S` My Comm.Expires Mar 22,2026 Jeanne Hagan
..,.Bonded through National Notary Assn. I
Printed Name of Notary
My Commission Expires:
23-0702/pg
3
Book: 2361 Page: 1763 Seq: 3