NCC243141_FRO Submitted_20241010

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
....-m""""11111111 SEDIMENTATION POLLUTION CONTROL ACT
. No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
�/AKE 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
,,,,,., v Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A. (�r 1. Project NameV1 \ O\\ +�\1\` CLCk LOk `-/� sa\nc_tws\-\
1/4....J
2. Location of land-disturbing activity: Jurisdiction J\ Q , CU'jf (Wake Co. or Municipality)
Highway/Street \C)\\ \\\ 0-o Latitude35..71961 Longitude"--7'8.,725i-tLI
3. Approximate date land-disturbing activity will commence: 6-eprem h c �jr��2c52.'--�
4. Type of development (residential, commercial, industrial, institutional, etc.):?--its dcr)--‘'G,
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 0 1(.
6. Person tocontact should erosion and sediment control issues arise during land-disturbing activity:
NamZekrrl\�\ \ 1056, -- 0 E-mail Address C`OA\C'.,\�ja','�. O 20'lc SAC 1\r\
2
Telephone Cell#9 C I-ZJ2.'3222. Fax#
7. Landowner(s)
of Record (attach accompanied page to list additional owners):
UNI\PeSi-A_ C: (1H-3%S�-63 H a the ,: s. .ec,,
et
Na (s) Telephone Fax or E-ma it address
2.2y `roweru ew r-t $Qxr\c 016 pno:\VInc3add r�
Current Mailing Address Current Street Address
Cry NC, 27513
City State Zip City State Zip
8. Deed Book No.D\ 1'Z5 Page No.CCri1'- —OC 4 7 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):
?' \ s
Na \ome i . )revP Rv t\nc ,)cD.CDrr).
E-mail Address 0
.2.2!--1 'Towerview c1 baffle a& rvci I ivlo Acdd i z
Current Mailing Address Current Street Address
Card KC `2-1hI�?
City State Zip City State Zip
Telephone 19-�`b6'-3` 3'H 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 Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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 information should there be any change in the information provided herein.
Type +etje • kfr , v
or print name Title or Authority
„___\>j..,
Signature al-
Date
)
I, r Ru nl„ I eve IA Lc. , a Notary Public of the County of 00.62
State of North Carolina, hereby certify that l-L _ t. PC( CpSc appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and not. '- _-i_,t*
, in say of . E r e Yv‘Ger, 20
, ,. Katrina la pUBi_IC
. ,.� `�r
NOTARY
ake County,NC � ._ i
W fires June 26,2029 Notary
My ossi Expires
My commission expires " 6/26(2029*

BK018723PG00074 WAKE COUNTY, NC
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED & RECORDED ON
09-29-2021 AT 16:06:30
STATE OF NC REAL ESTATE
EXCISE TAX: $380.00
BOOK: 018723 PAGE: 00074 - 00077
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Stamps: $380.00 Real Estate ID#: 0478021
After recording, MAIL TO: Grantee
The property does not include the primary residence of the Grantor. (NC GS,¢'105-317.2)
This instrument was prepared by: Moore& Alphin,PLLC (without title examination or tax advice given)
Brief description for the Index: Lot 54, Sanctuary at Yates Mill, Phase 2 Subdivision
THIS DEED is made this 20TH day of SEPTEMBER , 2021, by and between
GRANTOR GRANTEE
SANCTUARY PARTNERS,LLC POYTHRESS HOMES,INC.
A North Carolina limited liability company A North Carolina corporation
Grantor's Address: Grantee's Address:
610 Presidents Walk Lane 224 Towerview Court
Cary, NC 27519 Cary, NC 27513
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 or parcel of land situated in Swift Creek Township, Wake County,North Carolina, and being more
particularly described as follows:
See attached Exhibit A
TO HAVE AND TO HOLD the aforesaid lot or parcel of land, all improvements thereon, and all privileges and
appurtenances thereto belonging to the Grantee in fee simple.
Submitted electronically by Bowen Law Firm PC in
compliance with North Carolina statutes governing recordable
documents and the terms of the submitter agreement with the
Wake County Register of Deeds.

BKO18723PGO0075
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 ufall encumbrances, and that
Grantor will warrant and defend the title against the |uw[u| c|uinoo of all persons whomsoever, other than the
following exceptions:
/) The lien ofm/valorem real property taxes not yet due and payable.
2) All cuacmcntu, covenants, conditions, restrictions, and other matters set forth in the County land
records.
IN WITNESS WHEREOF, each Grantor has hereunto set his hand and seal, uuofthe day and year first set forth
in the notary acknowledgement below.
SANCTUARY PARTNERS,LLC
(SEAL)
An V, hnager
STATE OF NORTH C&RDL[N&—COUNTY OFWAKE:
I certify that the following person personally appeared before me this day and acknowledged to me that he/she
voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated:
Thomas J. Anhot
Date:� � /�� / �2- (
Notary 4VIKM3�---
/ / =
(Official Stamp or Nam
e: Casey J. Heim
it Mv commission expires: 7/9/2023
07-09-2023
ou
COMM. Exp

BK018723PG00076
Exhibit A
Lying and being in Swift Creek Township, Wake County, North Carolina and being more
particularly described as follows:
All of Lot 54 as shown on the maps entitled "Final Plat For Sanctuary at Yates Mill, Phase 2",
prepared by Cawthorne, Moss& Panciera, P.C. recorded at Book of Maps 2020, Pages 1401-1404,
Wake County Registry.
Property Address: 2301 Toll Mill Court, Raleigh, NC
Parcel ID #: 0478021

BK018723PG00077
EXHIBIT B
By acceptance of this Deed, Grantee agrees to be bound by all provisions and conditions of that
Agreement of Sale — Sanctuary at Yates Mill (Phase 2) dated September 10, 2020, between Poythress
Homes, Inc. and Sanctuary Partners, LLC, the developer of Sanctuary at Yates Mill Subdivision. This
agreement of Grantee shall be appurtenant to and run with title to the real property herein conveyed and
shall automatically terminate on the third anniversary of the date of recording of this Deed, unless
Developer records an extension of this agreement in the Office of the Register of Deeds for Wake
County, North Carolina, which extension shall not in any event be for longer than an additional three
years.
GRANTEE:
POYTHRESS HOMES, INC.
A North Carolina corporation
By: tJef--7 /9e17
Name: "reflA Pit)Y 777Lie.
Title: t
State of North Carolina— County of Wake
I certify that the following person personally appeared before me this day and acknowledged to me that
he signed the foregoing document in the capacity indicated and for the purposes stated therein:
0 „4-1
rrLi I CAI 1 k rth f`c
j (print name of signor above)
Date: I
ct 11 j
(Stamp or Seal)
Signature of Notary 10R. de),1-1
My commission expires:
ELIZABETH WARD BOWEN
Notary Public, North Carolina
Wake County
My Commission Expires
October 06, 2021
3