NCC242272_FRO Submitted (2)_20240726

Property Owner Agent Authorization Form
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
2405/2415 Innovation Loop Rd, Youngsville, NC 27596
Parcel ID: 1843-63-6123 , 1843-63-017
Property Owner Name(s)— please print:
Property Owner: Arrowrock IV Long Mill Phase 1 , LLC
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Scott M. Reese Arrowrock IV Long Mill , LLC
(Contractor/Agent) (Name of company)
to act on my behalf and take all actions necessary in the pursuit of developing this property, and in
obtaining any and all permit(s) or certification(s) required for aforementioned development.
Property Owners Mailing Address (if different than property address above):
Summit Real Estate Group
135 N Meramec Ave Suite 600 , St . Louis, MO 63105
Property Owner(s) Telephone: [phone]
We her ify that the above information submitted in this application is true and accurate to the
best of our knowledge.
,,0? -/ --(i
Authorize/� gyte Authorized Signature
Date``//�r// // Date
Personally appeared before me on this 'Vt day ofl? ( 20 .
My Commission expires on I ti/3i G20c1
beat:-4-4)-- (4 4r) / 0.10.1geo-y
Notary Signature/Seal LISA M DUNSWORTH natP
NOTARY PUBLIC-NOTARY SEAL
STATE OF MISSOURI
MY COMMISSION EXPIRES OCTOBER 31,2024
JEFFERSON COUNTY
COMMISSION 012408969