NCC205003_Annual Fee Payment Record_20211215

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 10/29/2021 7:57:09 AM (Workflow Start Event)
Submit by Evans, Shaundra M 12/15/2021 7:48:32 AM (2021 Annual Fee Payment Verification for NCC205003-
2021)
0 Daniel White
• Evans, Shaundra M assigned the task to Evans, Shaundra M 12/15/2021 7:47 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 10, 2021 5:00
PM 10/29/2021 7:57 AM

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Certificate of NCC205003
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2020-5003
No. *
Permit Status: Active
Year COC Issued 2020
This field will be hidden.
2020 Fee Status Check last year's fee status
Project Name* Green Hill Road Subdivision
Project Address* Green Hill Road, Youngsville, NC
Permittee* Brothers Development LLC
County Franklin
Invoice No.* NCC205003-2021
This is passed from the workflow when the invoice is fled.
Annual Fee* $ 100.00
Invoice Date* 11/1/2021
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 12/1/2021
This is passed from the workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue 14
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment • Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 12/15/2021
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.
Method of Payment* • electronic
check
other

ePayment 607895037
Transaction Number*
Fee Status* PAID
Legally Responsible Daniel White
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-mail address or site contact info
Original Billing E-mail (If available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 12/15/2021