NCG030245_Name Ownership Change_20180111

N
Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
LandQuality Section/Stormwater Permitting Data Recervaa
Q g Year Month Da
National Pollutant Discharge Elimination System
PERMIT NAMEIOWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit
(or) Certificate of Coverage
Ladies
0 3 0 _2T4_ 5
II. Permit status prior to requested change.
a. Permit issued to (company name):
Kaba Ilco Corp
b. Person legally responsible for permit:
Michael Kincaid
E-mail Address
dormakaba USA Inc
First MI Last
2941 Indiana Avenue
COO - Access Solutions Americas
Title
2941 Indiana Avenue
Permit Holder Mailing Address
Winston Salem NC 27105
City State Zip
( 336 ) 725-1331 ( 336 ) 464-1348
Phone Fax
c. Facility name (discharge):
Kaba Ilco Corp
d. Facility address:
2941 Indiana Avenue
Address
Winston Salem NC 27105
City State Zip
e. Facility contact person:
Ed Lodics ( 336 ) 464-1342
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of:
E Change in ownership of the facility
Fx Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
d. Facility name (discharge):
e. Facility address:
Address
Winston Salem NC 27105
City State Zip
f. Facility contact person: Ed Lodres
First Mi last
( 336 ) 464-1342 ed [e-mail]
Phonc E-mail Address
FV. Permit contact information (if different from the person legally responsible for the permit)
Revaed Jan. 27, 2014
dormakaba USA Inc.
Ed
Ladies
First
Intl Last
Vice President Operations
Titic
2941 Indiana Avenue
Permit Holder Mailing Address
Winston Salem NC 27105
City State Zip
( 336 ) 464-1342 ed [e-mail]
Phone
E-mail Address
dormakaba USA Inc
2941 Indiana Avenue
Address
Winston Salem NC 27105
City State Zip
f. Facility contact person: Ed Lodres
First Mi last
( 336 ) 464-1342 ed [e-mail]
Phonc E-mail Address
FV. Permit contact information (if different from the person legally responsible for the permit)
Revaed Jan. 27, 2014

R0
NPDES PERMIT NAMEIOWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Same
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V Will the permitted facility continue to conduct the some industrial activities conducted prior
to this ownership or name change?
❑x Yes
❑ No (please explain)
VI. Required Items: TRIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
Q This completed application is required for both name change and/or ownership change
requests.
❑x Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
uicnna
1,_, attest that this app 'ratio for a name/ownership change has been reviewed and is accurate and
complete to the best of my' knowl dge. I understand that if all required parts of tltis application are not
completednd that if al}'require supporting information is not included, this application package will be
returned asAncofnoletc.
Signature
Date
APPLICANT CERTIFICATION
I, Ed «—. attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
21" 1 � k ( Lc-(
S gnature Date
PLEASE SEND TETE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitling Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27. 2014

P®W 11eA Spruill LLP
� AN 1 1 2018 .
January 4, 2018
Laura Alexander
N.0 Dept. of Environmental Quality
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh NC 27699-1612
RE. Permit Name/Ownership Change Form — Kaba Ilco Corp
Dear Ms. Alexander:
H. Glenn T Dunn
Partner
D: 919 783 2842
F: 919.783 1075
[e-mail]
I am enclosing the original executed Permit Name/Ownership Change Form. If you need anything else or
have questions, let me know.
Very truly yours,
H. Glenn T. Dunn
Partner
HGD.kks
Enclosure
WWW.POYNERSPRUILL.COM RALEIGH / CHARLOTTE / ROCKY MOUNT / SOUTHERN PINES
301 Fayetteville Street, Suite 1900, Raleigh, NC 27601 PO Box 1801, Raleigh, NC 27602-1801 P 919 783 6400

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TH-S. 0ECIAL•. WARRANTY D= trade :this 20tb day of 1)ttaxiber, 2011, by KABA.
ILCO CORK A :North Carolina-cmIx)rMon, suet or' by merger to i aba BenzWg, .inm V'Oraatoe)"
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whose m aft 94drm- is, IO 8% 2627, P.4okyy Moumtz NC Z711M to KIWS PROPERTY LLC, a
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D914W= = lit'mil8ii 4404 oftpat y V-'Gn tt j whose mauling; address is: olo 1P0- Oox 2627, Plooky
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Mount, NC. 27802. 'Mw dedpation - irantur and Grantee as used hernia• shall include• sdd parties; th
belts, .sucemors, and as %w, and shall iodude singular, plavW, masculine, ftd tihe or water as required
by -context,
'iYI'1`MWTI , tha the Gramm•, for a valuable c0nsideradon paid by the Gaantoe, dw rewqn of
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which M. i by muoWleciged,1ps and by theso presents, &M grant, harguti, sell and WRvey unto tkte
t n=ft in ftp simile, A those cenda lots: or paneels of land situated in Porgth County, Nant Cxrefina
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and rrzorn parii IffrI described ona�tta� here'tc and hereby wde a part hereof (ilk
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Mw Pmpesty vas w4uired by baba Benning, IM, Gmtees prodoQwW6r 'Yore meter, by
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iatsttum ent recorded in Bo& 21A Pap 4237, Forsyth County Registry.
TO IWAVE AND TO HOLD the Pt and all rI
opert3r aud'alipurrettantx;: tliit bc)ougittg
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to the Grantee wdlts succc&sors and assrgns in'fee• simple.
rator 400v'enants W'th the Orantee, that- it is seized of the Property itt fee slxnple,.Itas the 4t to
COUVOY the Sane infie simple, that title is marketable and free. gated .dadr of all encumb rm wes, Arid &I it
•wiff WWMW WA delend the tftic amt the lm rful claims of all persons w'laom at-, fltltea' than the

S..k 3384 Page 415
exceptions listed on Exhibit B attached hereto ani s • e a part hereof (the ` Permittkd
Exceptions'.
The transfer of the Property by this Deed is made as a contribution to the capital of Grantee by
Grantor, Grantee's sole member.
The Grantor makes no representations or warranties about the physical condition of the Property,
and the Grantee accepts the Property AS IS subject to all existing conditions.
The Properly does not include the primary residence of Grantor.
SHE SIGNATURE PAGE FOLLOWS) `
2

Book 3384 Page 416
IN WITNESS WHREOF, the Grantor has duly executed the foregoing as of the day and year
fust above written.
GRANTOR
KABA ILCO CORP, a
North Carolina corporation
By:
Nam : Sandra. Heller
Title: Secretary
ACKNOWLEDGEM M
STATE OF a)(AYtCP
COUNTY OF S—I+4 o Ml ake d�
I certify that the following person(s) personally appeared before me this day, each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity
indicated: Sandia Heller the Secretary of Kaba Ileo Corp., a North Carolina corporation.
Date:
Official Signature ofNotary:
Notary's Printed or Typed Name —ktv n a. ��/Ib,!► o t cG(i ,Notary Public
My Commission Expires:FeL�ezr X13- 201 k
(Official Seal)
Signature Page
Special Wanuty Deed
(Kaba Ileo Corp. to KIWS Property LLC—Forsyth County. NQ

Book 3364 2age 417
Exhibit A
The Property
LYING AND BEING in the City of Winston-Salem, Winston Township, Forsyth County,
State of North Carolina, and beginning at an iron stake in the northeastern right of way line of
Indiana Avenue, said iron stake being the southernmost corner of Lot No. 74 as set out upon the
hereinafter referenced plat; and running thence along the northeastern right of way line of
Indiana Avenue North 41 ° 18'45" West 1,150.00 feet to an iron stake, said iron stake being the
southernmost comer of that tract now or formerly owned by Paul F. Martin (see Deed Book 1040
at Page 1712, Forsyth County Registry); thence along the southern boundary line of Martin,
North 481 40' East 308.42 feet to an iron stake, said iron stake being the easternmost corner of
Martin; thence along the southwestern right of way line of Southern Railway and the
northeastern boundary line of a portion of Lot No. 82 and all of Lot No. 81, 80, 79, 78, 77, 76, 75
and 74, all as shown upon the hereinafter referenced map, the five (5) following courses and
distances; along a curve to the right, a chord course and distance of South 580 24'05" East
237.70 feet to a railroad spike; continuing along a curve to the right, a chord course and distance
of South 510 33'28" East 237.59 feet to an iron stake; continuing along a curve to the right, a
chord course and distance of South 44° 21' 05" East 262.96 feet to an iron stake; continuing
along a curve to the right, a chord course and distance of South 370 42' 04" East 208.40 feet to
an iron stake, and South 24° 39' 04" East 419.00 feet to an iron stake, said iron stake being the
southeast comer of Lot No. 74 as set out upon the hereinafter referenced map; thence along the
boundary line of Lot No. 74, the two (2) following courses and distances; North 880 0310811
West 342.9 feet to an iron stake; and South 030 16'43" West 7327 feet to the point and place of
the beginning, same being all of Lot Nos. 74, 75, 76, 77, 78, 79, 80 and 81 and a portion of Lot
No. 82 as set out upon that plat entitled "Revised Map of Inverness Mills Company Property"
recorded in Plat Book 8 at Page 141 in the Office of the Register of Deeds of Forsyth County,
North Carolina, sante containing 10.963 acres, more or less, and being that same property
surveyed and platted by Larry L. Callahan, R.L.S. on the 22nd day of January, 1988, and being
further known as Tax Lot Nos. 82A, 81, 80, 79, 78 and 77, Tax Block 961, and Tax Lot Nos.
101, 75 aud74, Tax Block 963 as set out upon the tax maps in the Office of the Forsyth County
Tax Supervisor, as said tax maps are presently constituted.
The above being the same property conveyed to llco Unican Corp. by deed from StewartWamer
Corporation dated February 3, 1988, recorded in Book 1633, Page 0873, Forsyth County
Registry.
Exbibits
(Kaba rico . to YAWS Pso �&&Caen tyDeed
Corp pccty I�.0 —F Coun NC)

Book 3384 Page 418
E`xMbif B
Permitted Exceptions
1. All ad valorem taxes for 2017 and subsequent years; and
2. All easements, restrictions, rights of way and other matters of record affecting the property.
BANts
46dal wsaadty need
RaM Ilco Corp. to KIWS Property LLC Forsyth County, NC)
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