NCC242571_FRO Submitted_20240822

IOW WAKE COUNTY 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 Wake
WAKE
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
NORTH CAROL IN\ Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A. ,,l
1. Project Name D• 6 I 7 1"otck►'lC�v�S� `^ '
2. Location of land-disturbing activity: Jurisdiction w°1Ke— (Wake Co. or
ahoN i Municipality)
Highway/Street ItkS� Latitude ?S g 5-6 Longitude — b ' ? a
3. Approximate date land-disturbing activity will commence: —t 1 'lT
4. Type of development (residential, commercial, industrial, institutional, etc.): IeSiGe--I^d I CA I
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): y c a6
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name '6C-0A 15 `e-j E-mail Address A is e /UW101-tcmo-�O''�
Telephone Cell# 9 ('1 163 9ax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):N1IS 61\S (04fttAfion 119 7 3F9g 11460,.4,k6mtser; tit corv1
Name(s) II Telephone Fax or E-mail address
"ICA A/Vckt(t" Ge
Current Mailing Address Current Street Address
1Aia1&e -fir AJc , -1-c57
City q /State Zip City State Zip
8. Deed Book No. 6 I 1 b (..) Page No. Q `)-`)-Q Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet. Include requested information):
\/i ti 6(11'6 CONS-fitt 1 V*Ct cl I IlkOMEs I •co�1
Name E-mail Address ,,
Lta[ via t-1-
Current Mailing Address Current Street Address
A f AUC 7sg
City State Zip City State Zip
Telephone `"1 141�7� 7 3MFS Fax Number

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in
Wake County to receive any notice, process, pleading in any action or legal proceeding arising out of any
matter relating to the Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the egistered Agent:
VI/ kkI #51/r14 I 6441
Name of Registered Agent E-mail uicA\VAAre,
Mailing Address V
Current Street Address
(POI
City State Zip City State Zip
Telephone I IgY737 .S & Fax Number
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, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected informaton should there be any change in the infor ation provided herein.
tA.h(t
Pregi
Type or pr'nt name Title or Authority
Signature Date
I, P NM`tntA Ctdci i I , a Notary Public of the County of Par)W h'n
State of North Carolina, hereby certify that COCA (3a(d0, appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this I C day of -3:4 I , 20 24
P. NICOLE RAY CADDELL
NOTARY PUBLIC N y
Seal Franklin County
North Carolina My commission expires (Y 1 1/ 2 d 19
My Commission Expires 1 I ITIA4

tsnu VOJUrbULZUOTAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED & RECORDED ON
06-07-2024 AT 08:34:44
STATE OF NC REAL ESTATE
EXCISE TAX: $150.00
BOOK: 019630 PAGE: 02206-02207
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $150.00
Parcel Identifier No. 0366804 , Verified by County on the day of ,20_
By:
Mail/Box to: Grantee
This instrument was prepared by: North Carolina Real Estate Law Finn,6739 Falls of Neuse Road,Suite 201 Raleigh,NC 27615
**without title or tax advice given**
Brief description for the Index: Lot 53 Phase 5 Wakefield Meadows
THIS DEED made this day of/ 2/"/'/ ,201 y and between
GRANTOR GRANTEE
Woody Built,LLC, MB Homes Construction,Inc.a North Carolina corporation
a North Carolina limited liability company
Mailing Address:401 Wait Ave.,Wake Forest,NC 27587
209 W.Millbrook Rd.,Raleigh,NC 27609
Property Address: 1204 Tin Barn Rd.,Zebulon,NC 27597
The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns,and shall include
singular,plural,masculine,feminine or neuter as required by context.
WITNESSETH,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, parcel of land or
condominium unit situated in the county of Wake,North Carolina and more particularly described as follows:
Being all of Lot 53,Phase 5,Wakefield Meadows Subdivision as is shown on a map recorded in Book of Maps 2008,Pages 360,
361,&362,Wake County Registry.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 16057,Page 2171.
All or a portion of the property herein conveyed does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Book of Maps,Map Book 2008,Page 360-362.
submitted electronically by "Warren, shackleford & Thomas, P.L.L.C."
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Wake County Register of Deeds.

tSt�U'l UDJUVl:ULLU/
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.
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,other than the following exceptions:
Subject to current year ad valorem taxes and a valid survey.
Subject to liens,easements,restrictions,and/or rights of way of record which may include an obligation to pay assessments.
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
(SEAL)
ype Name: Woody Built,LLC
n K.Woody,III,Manager
(SEAL)
Print/Type Name:
•
State of North Carolina—County of AA(
I,the undersigned Notary Public of the County and State aforesaid,certify that John K.Woody,Ill,is the Manager of Woody Built,
LLC,a North Carolina limited liability company and acting on behalf of Woody Built,LLC as manager,personally appeared before
me this day and acknowledged the due execution of the foregoing instrument for the purposes therein expressed.
R y�,
Witness my hand and Notarial stamp or seal this R NA ON ,20 .1`(
Notary Public
h Durham County,North Carolina 61/4'
My Commission Expires: U . My Commission Expires _
�l Od! June 02,2025
• 4—— — ',Notary Pu lic