NCC242604_FRO Submitted_20240913

FUQIUAY-VAR I NA
north Carol/no
Financial Responsibility/Ownership Form SPCA
See TOFV LDO, Section§9-1407 SOIL EROSION &SEDIMENTATION CONTROL and Town Standards and Specifications for
additional details.
Part A.
1. Project Name South Lakes AR-1
2. Location of land-disturbing activity: Highway/Street Fuquay-Varina Parkway
3. Approximate date land-disturbing activity will commence: June 2024
4.Type of development (residential, commercial, industrial, institutional,etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas): 9.0 acres
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name James Woofter E-mail Address [e-mail]
Telephone [phone] Cell # 703-930-3069
7. Landowner(s) of Record (attach accompanied page to list additional owners):
DFC South Lakes, LLC
Name E-mail Address
13000 Sawgrass Village Circle, Ste 24 13000 Sawgrass Village Circle, Ste 24
Current Mailing Address Current Street Address
Ponte Vedra Beach, FL 32082-5021 Ponte Vedra Beach, FL 32082-5021
City State Zip City State Zip
8. Deed Book No.018825 Page No. 02408 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):
Dream Finders Homes
Name E-mail Address
7200 Falls of Neuse Rd, Suite 202 7200 Falls of Neuse Rd, Suite 202
Current Mailing Address Current Street Address
Raleigh, NC 27615 Raleigh, NC 27615
City State Zip City State Zip
Telephone [phone]
Town of Fuquay-Varina E. 134 N Main Street, Fuquay-Varina, NC 27526
[phone] E fuquay-varina.org

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in Wake Coun o
receive any notice, process, pleading in any action or legal proceeding arising out of any matter relating to the .,'n of
Fuquay-Varina Land Development Ordinance and/or Land Disturbance Permit:
Name E-mail ' .t - s
Current Mailing Address Current Street Address
City State Zip City State Zip
Telepho.-
(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 Registered Agent:
James Woofter james.woofte0dreamfindershomes.com
Name E-mail Address
7200 Falls of Neuse Rd, Suite 202 7200 Falls of Neuse Rd, Suite 202
Current Mailing Address Current Street Address
Raleigh, NC 27615 Raleigh, NC 27615
City State Zip City State Zip
Telephone [phone]
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 information should there be any change in the information provided
herein.
JAI' W oc ' VJC PI��11 t— oF L i:› &L.�P 4t h
Type or print name Title or Authority
GlJ ' C57/57 202 f<
Signat / Date
I, /4 6"edf g L,i-el c t , a Notary Publicl of the County of 1,✓C�C{.e
State of North Carolina, hereby certify that jaw e, 00(.f•�r 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 /6. day of /1/?4e , 20 y
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" 13 ��� '• Notary
Seal a My Comm.Exp.9 ///d3/` -2'7
11/23/2024 = My commission expires
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20221201