SW3170606 - Randy Marion Chevrolet of Statesville (2)

1
Iredell Count/
Property Data
Parcel Number: 4745142541.000
Inquiry Date: 5/30/2017
Disclaimer: While every effort is made to keep Information provided over the internet accurate and up-to-date, the County does not
certify the authenticity or accuracy of such information. No warranties, express or Implied, are provided for the records and/or mapping
data herein, or for their use or Interpretation by the User.
Property Map
Owner/Property Info
Tax Account Number. 80026072
Old Parcel Number: 01063350008002
Owner Name.._HOWARD FAMIL-Y-INVESTMENTS.1_LLC
Mailing Address: P 0 BOX 1410 STATESVILLE NC 28687
Property Location: GArrHER RD
Lot Number:
Legal Description: BELL+HOWARD PROPERTY SR1965
Municipal Information
Township Code: 01
City Code: 01
Neighborhood Code: 01002
Value Information - Current Year Property Record Card (PRC)
Building Value: 1372180
Other Building Features: 114500
Land Value: 1147800
Tax Assessed Value: 2634480
Deferred: 0
Land Information - Reoister of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning
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Owner/Property Info
Tax Account Number. 80026072
Old Parcel Number: 01063350008002
Owner Name.._HOWARD FAMIL-Y-INVESTMENTS.1_LLC
Mailing Address: P 0 BOX 1410 STATESVILLE NC 28687
Property Location: GArrHER RD
Lot Number:
Legal Description: BELL+HOWARD PROPERTY SR1965
Municipal Information
Township Code: 01
City Code: 01
Neighborhood Code: 01002
Value Information - Current Year Property Record Card (PRC)
Building Value: 1372180
Other Building Features: 114500
Land Value: 1147800
Tax Assessed Value: 2634480
Deferred: 0
Land Information - Reoister of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning

4, ,,L
20100301 CD 2052 56 22 956 AC B-4
Tax Information
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
Null C ADVLTAX C101ADVLTAX Null Null Null
Current Zoning Contact Info.
Iredell County
704.878.3118
Harmony
704.878.3118
Love Valley
704.878.3118
City of Statesville
704.878.3575
Town of Troutman
704.528 7600
Town of Mooresville
704.662 7040
Village of Davidson
704.892 7591

IIIlIIIIIIIIRIIIIIIIflllllllllllllllll�ll�Illlllill�IIIIIIIIIIIIIIIIIIIII�II
Recorded: 03/01/200100atT09:23C11 AM
Fee Amt: $14.00 Page 1 of i
Iredell County. NC
Brenda D. Bell Register of Deeds
BK2052PG56
North Carolina Department of The Secretary of State
CERTIFICATION OF CONVERSION
I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do hereby certify that
on the 16th day of March, 2009, Articles of Organization Including Articles of Conversion were filed in this
office
CONVERTING
THE HOWARD FAMILY LIMITED PARTNERSHIP NC
INTO
THE HOWARD FAMILY INVESTMENTS #1, LLC NC
a limited liability company duly formed under the laws of the State of North Carolina with its period of
duration being perpetual.
The name of the resulting entity was changed by virtue of said conversion to: NIA
The effective date of said conversion, if different from the date of filing was: N/A
The resulting entity has not filed article's of dissolution and continues to be in existence in this State as
of the date of this certificate.
I FURTHER certify that this certificate is in compliance with North Carolina General Statutes §47-
18.1 and §55D-26 and may be recorded in the office of the Register of Deeds in the same manner as deeds, the
name of the resulting entity appearing in the "Grantee" index.
Certification# 89921260-1 Reference# 9959501-gs Page: 1 of 1
Verify 'this certificate online at www.secretary.state.nc.us/verification
IN WITNESS WHEREOF, I have hereunto
set my hand and affixed my official seal at
the City of Raleigh, this 22nd day of
February, 2010.
Secretary of State

Yredell County
Property Data
Parcel Number: 4745243304 000
Inquiry Date: 5/30/2017
Disclaimer: While every effort is made to keep Information provided over the internet accurate and up-to-date, the County does not
certify the authenticity or accuracy of such Information. No warranties, express or Implied, are provided for the records and/or mapping
data herein, or for their use or interpretation by the User.
Property Map
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Owner/Property Info
Tax Account Number: 77447506
Old Parcel Number: 0106335000B001B
OWner-N arae.--DAW N -PROPERTIES'[
�_-`
MaIIInJ Address. _PO BOX 1559 MOORESVILLE NC 28115
Property Location: GAFFHER RD
Lot Number:
Legal Description: HOWARD BELL NCDOT 2165-927
Municipal Information
Township Code: 01
City Code: 01
Neighborhood Code: 01002
Value Information - Current Year Property Record Card PRC
Building Value: 0
Other Building Features: 0
Land Value: 459030
Tax Assessed Value: 459030
Deferred: 0
Land Information - Reolster of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning

20140811 WD 2312 2353 5.564 AC B-4
Tax Information
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
Null C ADVLTAX CIOlADVLTAX Null Null Null
Current Zoning Contact Info.
Iredell County 704 878.3118
Harmony 704.878.3118
Love Valley 704 878 3118
City of Statesville 704.878.3575
Town of Troutman 704 528 7600
Town of Mooresville 704.662.7040
Village of Davidson 704 892 7591

�Q'
Type: CONSOLIDATED REAL PROPERTY
Recorded: 8/11/2014 12:51:19 PM
Fee Amt: $946.00 Page 1 of 3
Revenue Tax: $920.00
Iredell County, NC
Matthew J. McCall Register of Deeds
BK 2312 PG 2353 - 2355
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $ 9 20 oa
Parcel Identifier No. 4745243304 Verified by County on the day of , 20
By: /-
MaillBox to: C� an4lo
This instrument was prepared by: William P. Pope, Pope McMillan Kutteh & Schieck, P.A.
Brief description for the Index: +/- 6.3781ac on Gaither Rd
THIS DEED made this � day of August , 2014, by and between
GRANTOR
Timothy R. Bell, Trustee of the Edward R. Bell,
Decant Trust dated March 30, 2014
(50% undivided interest), and
Lou M. Bell
(50% undivided interest)
i
GRANTEE
Dawn Properties, LLC
P.O. Box 1559
Mooresville, NC 28117
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 ofwhich 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 City of Statesville, Chambersburg Township, Iredell County, North Carolina and more particularly described as
follows:
SEE ATTACHED EXHBIT A
THE DRAFTER OF THIS INSTRUMENT DID NOT PERFORM A TITLE SEARCH AND DID NOT
PARTICIPATE IN THE CLOSING OF THIS TRANSACTION.
NC Bar Association Form No 3 © 1976, Revised © 1/1/2010, 2013
Printed by Agreement with the NC Bar Association
This standard form has been approved by
North Carolina Bar Association — NC Bar Form No 3
ROTC Page CounO
NS PQ Sf

The property hereinabove described was acquired by Grantor by instrument recorded in Book 2302 Page 16 and Book 529 Page 233.
All or a portion of the property herein conveyed _ includes or _X_ does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book page
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:
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
By: — SEAL
'timothy PL Deill, Trustee
EDWA3P R. BELL DEC TRUST dated March 30, 2014
BAY _`?— (SEAL)
Lod'M. Belly6y her Atforney-in-Fact Timothy Ross Bell
State of North Carolina - County of
,� 5 `
1, 3, ,. T 11oi-u-/ > a Notary Public for Z7,.,, JL `� County and State, do hereby certify that Timothy
Ross Bell, attorney in fact for Lou M. Bell, personally appeared before me this day, and signed the foregoing instrument for and in
behalf of Lou M. Bell, and that authority to execute and acknowledge said instrument is contained in an/ineduly executed,
acknowledged, and recorded in the office of the Register of Deeds of Iredell County, State of North Ca23rd day of
June, 2004, in Book 1562 page 2128, and that this deed was executed under and by virtue of the authorsaid instrument
granting power of attorney. Witness my hand and Notarial stamp or seal this �� day of August, 20
BEN S. THOMAS '
NOTARY PUBLIC
My Commission Expires: IREDELL COUNTY Notary Public
(Affix Seal) STATE OF NORTH CAROLINA Notary's Printed or Typed Name
aAY COMMISSION EXPIRPS 03-01-2011
State of North Carolina - County of - ✓', a., L I
I, the undersigned Notary Public of the County of -r `l6` and State aforesaid, certify that
Timothy R. Bell personally came before me this day and acknowledged that he is the Trustee of the Edward R. Bell ecant Trust
dated March 30, 2014 and that by authority duly given and as the act of such entity, he signed the foregoing ins ent in its name
on its behalf as its act and deed. Witness my hand and Notarial stamp or seal, this § day of August, 20
My Commission Expires: BEN S, THOMAS Notary Public
(Affix Sea]) NOTARY PUBLIC Notary's Printed or Typed Name
IREDELL COUNTY
STATE OF NORTH CAROLINA
MY COMMISSION EXPIRES 03-01-2017
-------------
2
NC Bar Association Form No 3 © 1976, Revised © 111/2010, 2013 This standard form has been approved by
Printed by Agreement with the NC Bar Association North Carolina Bar Association — NC Bar Form No 3

EXHIBIT A
Beginning at an existing iron pin in the Northern boundary of the right-of-way of Gaither Road in the Southwest
comer of SAI Investment Corp. (see Book 770, page 715, Iredell County Registry), said existing iron pin also being
located 1,141.40 feet South 88 degrees 38 minutes 04 seconds West from an NCGS Concrete Monument known as
°Johnson° having the grid coordinate of N=753,861.752 and E=1, 443,339.502, and running thence with the Northern
right-of-way with Gaither Road the following courses and distances: South 78 degrees 43 minutes 34 seconds West
38.98 feet to a point and South 87 degrees 22 minutes 54 seconds West 201.48 feet to an existing iron pin and South 85
degrees 10 minutes 18 seconds West 79.45 feet to an existing concrete monument and South 80 degrees 12 minutes
34 seconds West 73.86 feet to an existing iron pin; thence leaving the right -0f -way of Gaither Road, a new line
North 09 degrees 58 minutes 32 seconds West (passing through an iron pin set at 453.07 feet) 755.73 feet to a point
under the Duke Power Company Tower Line in Morrison Creek and in the Northern boundary of a certain 60- foot
Roadway Easement and in the line of the City of Statesville ( see Book 182, page 103 and Book 201, page 97 and
Book 503, page 500, Iredell County Registry); thence with the line of the City of Statesville following Morrison
Creek and the Northern boundary of the 60 -foot Roadway Easement the following courses and distances: South 69
degrees 59 minutes 06 seconds East 200.82 feet to a point and South 81 degrees 03 minutes 16 seconds East 96.41
feet to a point and North 71 degrees 36 minutes 14 seconds East 160.70 feet to a point in Morrison Creek in the
Northern boundary of that certain 60- foot Roadway Easement, comer with Richard A. Edmiston, et al. (see Book 646,
page 634 and Book 680, page 790 and Book 788, page 783 and Book 795, page 411, Iredell County Registry); thence
with the line of Edmiston and continuing on with the line of SAI Investment Corp., South 07 degrees 15 minutes 16
seconds East 680.67 feet (passing through an existing iron pin at the Southern boundary of the 60 -foot Roadway
Easement at 74.00 feet and passing through an existing iron pin at the comer of Edmiston and SAI at 360.70 feet) to
the point of BEGINNING, and being prepared in accordance with a plat drawn by Kestler Surveying, Inc., dated
February 25, 1994, and revised on September 14, 1995, and revised again on September 26, 1995, entitled Survey
for Lou M. Bell and William P. Howard," containing 6.3781 acres, more or less. For back title see Deed Book 529, page
233, Iredell County Registry. Less and except that portion of the above described property conveyed to the N.C.
Department of Transportation in the current Judgment in the Civil action entitled Department of Transportation vs. Lou M.
Bell, et al.,( 2010 CVS -2612). The above property is conveyed subject to the easement recorded in Book 1237, page
1327, Iredell County Registry.
The above property is conveyed subject to the rights, if any, of Horizon Outdoor Advertising pursuant to the
Memorandum of Lease dated March 1, 1998 and recorded at Book 1060, Page 0122 of the Iredell County Registry.
NC Bar Association Form No 3 © 1976, Revised © 1/1/2010, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association — NC Bar Form No 3

IV
Yredell County
Property Data
Parcel Number: 4745149307.000
Inquiry Date: 5/30/2017
Disclaimer: While every effort is made to keep information provided over the internet accurate and up-to-date, the County does not
certify the authenticity or accuracy of such information. No warranties, express or implied, are provided for the records and/or mapping
data herein, or for their use or interpretation by the User.
Property Map
Owner/Property Info
Tax Account Number: 80040112
Old Parcel Number: 010673500013003
§-:E.r:ame: DAWN PROPERTIES LLC
Mailing Address 220 W PLAZA DR MOORESVILLE NC 28117
Property Location. GAITHER RD
Lot Number:
Legal Description: BELL+HOWARD PROPERTY DOT2090-775
Municipal Information
Township Code: 01
City Code* 01
Neighborhood Code: 01002
Value Information - Current Year Property Record Card (PRC)
Building Value: 765450
Other Building Features: 47820
Land Value: 569920
Tax Assessed Value: 1383190
Deferred: 0
Land Information - Resister of Deeds Online Search
Date Recorded Document Type Deed Book Deed Page Plat Book & Page Land Area Land Type Zoning

20161122 WD 2459 1127 7 124 AC B-4
Tax Information
Exemption Tax Code 1 Tax Code 2 Tax Code 3 Tax Code 4 Tax Code 5
Null C ADVLTAX CIOlADVLTAX Null Null Null
Current Zoning Contact Info.
Iredell County
704 878 3118
Harmony
704 878 3118
Love Valley
704 878 3118
City of Statesville
704.878.3575
Town of Troutman
704.528.7600
Town of Mooresville
704.662.7040
Village of Davidson
704 892 7591
r

Type: CONSOLIDATED REAL PROPERTY
Recorded: 11/22/2016 1:47:56 PM
Fee Amt: $2,476.00 Page 1 of 3
Revenue Tax: $2,450.00
Iredell County, NC
Ronald N. Wyatt Register of Deeds
BK 2459 PG 1127-1129
This instrument drafted
by: Russell W. Chapman,
Jr., Attorney at Law
No Title Opinion Rendered or
Closing Held by Preparer
Revenue Stamps:
$2450.00
STATE OF NORTH CAROLINA GENERAL WARRANTY DEED
IREDELL COUNTY ,
This deed, made and entered into this 15th day of November, 2016, by and between THE
HOWARD FAMILY INVESTMENTS #1, LLC, a North Carolina limited liability company, whose
address is: 403 Deauville Road, Statesville, North Carolina 28625 ("Grantor") and DAWN
-PROPERTIES, LLC, a North Carolina limited liability company whose address is: 220 West Plaza
Drive, Mooresville, North Carolina 28117 ("Grantee").
The said Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other good and
valuable consideration to it in hand paid by the said Grantee, the receipt of which is hereby
acknowledged, has bargained and sold, and by these presents does grant, bargain, sell, and convey unto
the said Grantee, and its successors and/ or assigns, that certain tract or parcel of land lying and being in
the City of Statesville, Inside Township, Iredell County, North Carolina, and more particularly described as
follows:
SEE ATTACHED LEGAL DESCRIPTION
The property conveyed herein is not the principal residence of the Grantor.
To have and to hold the aforesaid tract or parcel of land, together with all privileges and
appurtenances thereunto belonging to it, the said Grantee and its successors and assigns, in fee simple
forever.
And the said Grantor does covenant that it is seized of said lands in fee and has the right to
convey the same in fee simple, that the same is free and clear of all encumbrances, and that it will
warrant and defend the title herein conveyed against the lawful claims of all persons whomsoever.
In Testimony Whereof, the said Grantor has hereunto set it hand and seal the day and year first
above -written.
THE HOWARD FAMILY VES ENTS, LL
B.
4nda-H*'J, Manager
�\ o `% /

Seal -Stamp NO CAROLINA, Ire ll County.
I, 0 rrA I g), tA_q^ , a Notary Public of the
County and State aforesaid, certify that Linda H. Howard and James
P. Howard, Managers of The Howard Family Investments #1, LLC,
Y Grantor, personally appeared before me this day and acknowledged
C
the execution of the foregoing instrument on behalf of the company.
CJ
E Witness my hand and official stamp or seal, this qday of
h .74 ST—
November,
TNovember, 2016.
Notary Public
My Commission expires:
RUSSELL W. CHAPMAN, JR.
NOTARY PUBLIC
Iredell County, IVC
Commission Expires .duly 6, 202

PIN: 4745-14-9307
MAP NO: 01-06J35000B03
Mailing Address: 615 Gaither
EXHIBIT R,
Road, Statesville, NC 28625
BEGINNING at an existing iron pin in the'northern boundary of the right-of-way of Gaither Road, said
existing iron pin being located the following courses and distances from 'an NCGS Concrete Monument
known as "Johnson" having the grid coordinates of N=753,861.752 and E=1,443,339.502: South 88 deg. 38
min. 04 sec. 'West 1,141.40 feet to an existing iron pin in the southwest comer of SAI investment Corp. (see
Book 770, page 715, Iredell County Registry) and along the northern right-of-way of Gaither Road, South 78
deg. 43 main. 34 sec. West 38.98 feet to a point and South 87 deg. 22 min.. 54 s6c. West 201.48 feet to an
existing iron pin• and South 85 deg. 10 min. 18 sec. West 79.45 feet to an existing concrete monument and
South 80 deg, 12 min, 34 sec, West 73.86 feet (the BEGINNING point); thence from the point of beginning
and continuing with the northern right-of-way of Gaither Road the following courses and distances: South
80 deg. 12 min. 34 sec. West 117.70 feet to an existing iron pin and South 80 deg. 16 min. 34 sec. West
276.08 feet to an iron pin set; thence leaving the right-of-way of Gaither Road, a new line North 09 deg. 08
min. 33 sec. West (passing through an iron pin set at 378.91 feet and another iron pin set at 622.19 feet)
828.46 feet to a point in Morrison Creek and in the northern boundary of a certain 60 -foot roadway easement
and in the line of the City of Statesville (see Book 182, page 103; Book 201, page 97; and Book 503, page
500, Iredell County Registry); thence with the line of the City of Statesville following Morrison Creek and
the northern boundary of the 60 -foot roadway easement the following courses and distances: South 82 deg.
08 min. 26 sec. East 15.69 feet• to a point; South 68 deg. 08 min. 26 sec. East 90.40 feet to a point; North 61
deg. 51 min. 34 see. East 93.00 feet to a point; North 51 deg. 11 min. 34 sec. East 82.20 feet to a point; South
58 deg; 10 min, 20 sec. East 65.91 feet to a point; and South 69 deg. 59 min. 06 sec. East 92.92 feet to a
point in Morrison Creek in the northern boundary of that certain 60 -foot roadway easement, a new comer
with Lou M. Bell xecorded concurrently with the . deed recorded in Deed Book 962, page 1949, Iredell
County Registry; thence with a new line of Bell, South 09 deg: 58 min.. 32 sec. East 755.73 feet (passing
through an iron pin set at 302.0 feet) to the point of BEGINNING, and being prepared in accordance with a
plat drawn by Kestler Surveying, Inc., dated 2/25/1994 and revised on 9/14/1995 and 9/26/1995 entitled
"Survey for Lou M. Bell and William P. Howard," containing 7.1.460 acres, more or less.
For back title see Deed,Book 962, Page 1946 and Deed Book 962, Page
1949, Iredell County Registry. -
THERE IS EXCEPTED from the above all of that property described in Deed
Book 2090, Page 775 - 777, Iredell County Registry.
See also Certificate of Merger converting The Howard Family Limited
Partnership into The Howard Family Investments 41, LLC, recorded
at Deed Book 2052, Page 56, Iredell County Registry.

LIMITED LIABILITY COMPANY ANNUAL REPORT
NAME OF LIMITED LIABILITY COMPANY: Randy Marion Chevrolet of Statesville, LLC
SECRETARY OF STATE ID NUMBER: 1262060 STATE OF FORMATION: NC
REPORT FOR THE YEAR: 2017
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Randall L. Marion
2. SIGNATURE OF THE NEW REGISTERED AGENT:
3. REGISTERED OFFICE STREET ADDRESS & COUNTY
215 W Plaza Dr
Mooresville, NC 28117-8229 Iredell
Filing Office Use Only
❑ Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
4. REGISTERED OFFICE MAILING ADDRESS
PO Box 1559
Mooresville, NC 28115-1559 Iredell
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Automobile Sales
2. PRINCIPAL OFFICE PHONE NUMBER: [phone]
4. PRINCIPAL OFFICE STREET ADDRESS & COUNTY
215 W Plaza Dr
Mooresville, NC 28117-8229 Iredell
3. PRINCIPAL OFFICE EMAIL:
O �
5. PRINCIPAL OFFICE MAILING ADDRESS
PO Box 1559
Mooresville, NC 28115-1559 Iredell
SECTION C: COMPANY OFFICIALS (Enter additional Company Officials in Section E.)
NAME: Bell & Howard Chevrolet NAME: Randall Marion
TITLE: Member TITLE: Member
ADDRESS:
601 Gaither Road
Statesville, NC 28625 Iredell
ADDRESS:
162 Sailview Rd.
NAME: Randy Marion Incorporated
TITLE: Manager/Member
ADDRESS:
P O Box 1559
Mooresville, NC 28117 Iredell Mooresville, NC 28211 Iredell
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
SIGNATURE
Form must be signed by a Company Official listed under Section C of this form.
Print or Type Name of Company Official
DATE
Print or Type The Title of the Company Official
+R1
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $200
MAIL TO: Secretary of State, Corporations Division, Post Office Box 29525, Raleigh, NC 27626-0525
■

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
TITLE -
ADDRESS:
NAME:
TITLE:
ADDRESS:
Name:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:

r North Carolina Department of the Secretary of State
Elaine F. Marshall, Secretary
BELOW IS THE CHECK LIST FOR LIMITED LIABILITY COMPANY ANNUAL REPORT. Please take a few minutes and read the
information provided. The Limited Liability Company Annual Report is due bry April 15th of each year, with the filing fee of
200.00.
Each Limited Liability Company filing an annual report with the North Carolina Department of Secretary of State must
provide the following information:
1. NAME OF LIMITED LIABILITY COMPANY
2. STATE OF FORMATION
3. ANNUAL REPORT FILING YEAR
4. THE REGISTERED AGENT'S NAME AND SIGNATURE IF CHANGED
5. THE REGISTERED AGENT'S STREET ADDRESS AND MAILING ADDRESS IF DIFFERENT.
6. THE PRINCIPAL OFFICE ADDRESS, COUNTY AND TELEPHONE NUMBER
7. THE NAMES, TITLES AND BUSINESS ADDRESSES OF THE COMPANY OFFICIALS
8. A BRIEF DESCRIPTION OF THE NATURE OF BUSINESS
IF THE INFORMATION REQUIRED TO BE ENTERED IN SECTION A THROUGH SECTION C HAS NOT CHANGED SINCE THE MOST
RECENTLY FILED ANNUAL REPORT, COMPLETE HEADER SECTION AND SECTION D TO CERTIFY THE ANNUAL REPORT.
SECTION A: REGISTERED AGENT'S INFORMATION
1. The name of the registered agent must be typed or printed
2. If the registered agent has changed, the new registered agent MUST SIGN CONSENT to the appointment in the space provided. If the registered agent's
name has changed due to marriage, or by any other legal means, the limited liability company must indicate such change in the space provided and have the
agent sign consent to the appointment under their new name. If the new registered agent is a business entity, then the appropriate representative of that
entity must sign and print their name and title. The registered agent must reside in North Carolina.
3. If the street address of the registered office has changed, indicate the change. The address of the registered office must be a Street Address and NOT a
Post Office Box Address. The street address of the registered office must be a North Carolina address.
4. If the mailing address of the registered office has changed it should be indicated in this item. The registered office's mailing address may be a Post Office
Box. The registered office mailing address must be a NORTH CAROLINA ADDRESS.
SECTION B: PRINCIPAL OFFICE INFORMATION
1. Provide a brief description of the nature of the LLC's business.
2. Enter the principal office telephone number.
3 Enter the principal office E-mail address.
4. The principal office address should reveal the limited liability company's physical location. The principal office street address must be a street address
and NOT a Post Office Box Address.
5. The principal office mailing address may be a Post Office Box.
SECTION C: COMPANY OFFICIALS
1. Enter the name, title and business address of each company official. Use Section E or a plain 8 1/2 X 11 sheet of paper if more space is needed. A
person listed in this section must sign the annual report and is then authorized to sign on other documents filed with this office.
SECTION D: CERTIFICATION OF ANNUAL REPORT
1. Check the annual report carefully to ensure all information required for filing has been provided Only a company official listed on this report or past
completed and filed report may sign. Complete the signature, date, title and typed or printed name in the space provided on the form to certify that the
information is accurate and current. If the company official is another business entity then the appropriate representative of that business entity must certify
the annual report.
SECTION E: ADDITIONAL COMPANY OFFICIALS
1. Enter the name, title, and business address of each additional company official. A person listed in this section is then authorized to sign on other
documents filed with this office.
Mail the annual report to: Secretary of State, Corporations Division, Post Office Box 29525, Raleigh, NC 27626-0525.
For information or assistance, please contact the Corporations Division at [phone] or Toll Free 1-888-246-7636.
Web address is http://www.sosnc.com

Letter of
Transmittal
To:
NCDEQ
Stormwater Dept.
217 West Jones St.
Raleigh, NC 27603
Att: WQ Reviewer
877-623-6748
Piedmont Design Associates, P.A.
125 East Plaza Drive, Suite 101
Mooresville, NC 28115
[phone]
Fax: [phone]
Email: [e-mail]
Job Number: 2015-06-03
RANDY MARION FORD
Gaither Road Project
(WATER QUALITY REVIEW SUBMITTAL 1)
DATE
For approval
May 31, 2017
COPIES
NO.
DESCRIPTION
2
plans
CIVIL CONSTRUCTION PLANS (Full Size 24"x 3611)
2
report
STORMWATER CALCULATIONS REPORT
❑
Returned for ❑ Return
(Includes USGS Soils Data, Storm -EZ Application and O & M Document)
1
docs
ADDITIONAL DOCUMENTS (Deeds, State LLC)
1
check
REVIEW FEE CHECK ($505.00)
For review & comment
CEIVro
These are transmitted
®
For approval
❑
Approved as submitted ❑ Resubmit
❑ copies for app.
❑
For your use
❑
Approved as noted ® Submit
❑ copies for dist.
®
As requested
❑
Returned for ❑ Return
❑ corrected prints
corrections
®
For review & comment
CEIVro
❑
FOR BIDS DUE:
JUN 07 201i
REMARKS:
I)MR-LAND QUALITY
Alw�;A: _ _ ,--
This submittal is for Water Quality review only. A detention review rigs already been done by the City of
Statesville Engineering Department. Please review and if you have any questions, give myself or Donald L.
Munday of our office a call.
Signed: — 'W1 / A �/A -
Jet h1Ing, Projg t lljianager
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