NCC241675_FRO Submitted_20240614

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FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM NolteSoil Erosion and Sedimentation Control Ordinance NORTH CAROLINA
Instructions: No person shall initiate any land-disturbing activity on one or more acres, as covered in the Town of
Huntersville Soil Erosion and Sedimentation Control Ordinance,before this form and an acceptable erosion and
sedimentation control plan have been completed and approved by the Town of Huntersville. The Financially
Responsible Party will be on record as the party to accept any Notices of Violation or related documents for any non-
compliance of the Town of Huntersville Soil Erosion and Sedimentation Control Ordinance. If the Financially
Responsible Party resides out of state, a North Carolina agent must be assigned. All items on this form must be
filled out accurately and completely.
PART A—PROJECT AND LANDOWNER INFORMATION
1. Project name Mt. Holly - Huntersville Industrial
2. Address of land-disturbing activity(number, street) 12021 Mt Holly-Huntersville Rd
3. Approximate date land-disturbing activity will begin 01/15/2023
4. Purpose of development(Commercial, Residential, Industrial
Industrial, etc.)
5. Total acreage of land to be disturbed or uncovered 16.0 Acres
6. Total site acreage 15.0 Acres
7. Landowner(s) of Record. The names listed below must match the Deed(s).Attach a list of additional owners, if
applicable.
Note: If the landowner of record is not the person(s)firm(s),or Company's Financially Responsible Party,
as listed in Part B, item 1, a separate Letter of Consent, signed and dated by the Landowner of
Record or their Authorized A_ent,is re I uired.
Landowner 1 of Record
Company Name Contact Name
(if applicable) Luna Loco
Mailing Address 13131 Iris Dr
City Huntersville State NC zip J28078
Phone Email
Landowner 2 of Record
Company Name Contact Name
(if applicable) Larry Dean Mercer
Mailing Address 121 Fox Run Ln
City Stanley State NC Zip 28164
Phone Email
8. Indicate the Deed Book and Page number where the deed or instrument is filed. Attach a list of additional deeds
if applicable.
Deed Book Page Deed Book Page 11 Deed Book Page
31741 788
37295 513
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Rev. 8/2022 TOH Staff Reviewer Ownership/Agent: Verified at Pre-Con Meeting By: Page 1 of 2

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FINANCIAL RESPONSIBILITY OWNERSHIP (FRO) FORM crk, lte of. e
Soil Erosion and Sedimentation Control Ordinance N O RI I C A R O L I N A
PART B —FRO AND NC REGISTERED AGENT
1. Person(s), firm(s)or Company who is/are financially responsible for this land-disturbing activity.
Financially Responsible Party
Company Name(if applicable) Seefried Industrial Properties,INC. Contact Name Joseph Scarborough
Mailing Address 3333 Riverwood Parkway SE, Suite#200
City Atlanta State GA ZIP 30339
Phone [phone] Email [e-mail]
2. If the Financially Responsible Party listed above does not reside in the state of North Carolina,they must
provide a designated North Carolina agent below. This agent must be registered with/on the NC Secretary of
State business re.istrv.
North Carolina Agent for Financially Responsible Party
NC Registered Agent Name COGENCY GLOBAL INC. Contact Name
Mailing Address 212 South Tryon Street Suite 1000
City Charlotte State NC Zip 28281
Phone [phone] Email
3. (Optional)Additional contact familiar with the site,who understands the plans, and may represent the company.
Site Contact's Name Email
Phone: Office Phone: Mobile
PART C — SIGNATURE WITNESSED BY A NOTARY PUBLIC
DO NOT SIGN THIS FORM UNTIL YOU ARE IN I I IF PRESENCE OF A NOTARY PUBLIC
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, or his attorney-in-fact. If the
Financially Responsible Owner is not an individual,this form must be signed 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.
Printed Name 112.kb (2_01,kitS 1 n Title or Authority 'W(Sa
Wet-Ink Signature Pool.,� Date
I, Agrnrl C rrxq , a Notary Public of the County of C06‘,
State of C,ep(1q , hereby certify that Q oko eA cS►el personally
appeared before me this day and being duly sworn acknowledged that the above form was executed by him/her.
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Witness my hand and notarial seal, this 2 day of NOVgyvkke r , 20 23 .
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Rev. 8/2022 Page 2 of 2