NCC210160_Contact Update Record (Leg Resp Change)_20220419

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 4/19/2022 8:52:21 AM (Contact Changes Submitted)

Certificate of NCC210160
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-0160
Original NOI No.* 40714
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Hendrix Brothers of Hoke, LLc
Project Name Blackhawk Landing
Address Rockfish Road, McLauchlin, NC
County Hoke
Latitude 35.0000
Longitude-79.0000
Date COC Issued * 01 /11 /2021
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Ralph Huff
Individual (Previous)
First Name (New)* David
Last Name (New)* Vannoy

NEW Legally Reflects any revisions above
Responsible David Vannoy
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2919 Breezewood Avenue, 0, Fayetteville,
Address (Previous) NC 28303-5283
NEW Permittee Street Address
Mailing Address* 2919 Breezewood Avenue
Address Line 2
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28303
us
Permittee Street 2919 Breezewood Avenue, 0, Fayetteville,
Address (Previous) NC 28303-5283
NEW Permittee Street Street Address
Address* 2919 Breezewood Avenue
Address Line 2
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28303
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Lee Humphrey
(Previous)
Site Contact Title Managing Partner
(Previous)
Organization Hendrix Brothers of Hoke, LLC
(Previous)
First Name (New)* Lee
Last Name (New)* Humphrey
NEW Site Contact* Reflects any revisions above
Lee Humphrey

NEW Site Contact Managing Partner
Title
NEW Organization Hendrix Brothers of Hoke, LLC
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 9106848646
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 150 S. Page Street, 0, Southern Pines, North
Address (Previous) Carolina 28387
NEW Site Contact Street Address
Mailing Address* 150 S. Page Street
Address Line 2
City
State / Province / Region
Southern Pines
North Carolina
Postal / Zip Code
Country
28387
United States
Change Requested Kathryn Brown via Modification request submitted 4/13/2022. Follow-up clarification
by: * and confirmation by Rebecca Treadaway on 4/19/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Confirmed with representative (R. Treadaway) that permitted entity did not change.
(Optional) Hendrix Brothers of Hoke, LLC is a special purpose entity, used solely for this
particular project. RHH Land Investors, LLC oversees the project and this project
LLC (see email correspondence). Site contact has not changed, but the email has
been updated to Ms. Treadaway's.
Date * 04/19/2022