NCC222726_FRO Submitted_20220729

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project NameTransportation Investment for Revitalization
2. Location of land -disturbing activity: County Robeson City or Township Pembroke
Highway/Street711 _ Latltude(decimaldegrees )34'4 Long ltude(decimaldegrees) 79. 1
3. Approximate date land -disturbing activity will commence: February, 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): public improvement
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 11
6. Amount of fee enclosed: $ 1100 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑x No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameTyler Thomas E-mail [e-mail]
Phone: Office # 91 0-521-9758 Mobile #
Landowner(s) of Record (attach accompanied page to list additional owners):
NCDOT ROW N/A N/A
Name
Current Mailing Address
City
Phone: Office #
Current Street Address
State Zip City
State
Mobile #
Zip
10. Deed Book No. Page No. Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the companyis a sole proprietorship orif the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Town of Pembroke
Company Name
98 Union Chapel Rd
Current Mailing Address
Pembroke, NC, 28372
[e-mail]
E-mail Address
98 Union Chapel Rd
Current Street Address
Pembroke, NC, 28372
City State Zip City State Zip
Phone: Office # 91 0-521-9758 Mobile #
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
N/A
Name of Registered Agent
E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
N/A
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
N/A
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Tyler Th
Type or print na
Signature
as
Town Manager
Title or Authority
Date
ir- 31
I, V�:I, , a Notary Public of the County of RzbeLO
State of North Carolina, hereby certify that appeared personally
before me this day and being duly sworn acknowl dged that the above form was executed by him/her-
Witness my hand and notarial seal, this day of _ 20 as
y�1441111!llllllllryri
TARk
0�'�. pUBL\G
rrlrlllllffllll lllllllH����
Notary
My commission expires ko - a--`{--®

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
THE COMMONS AT PEMBROKE, LLC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02009
Page No. 0712 Provide a copy of the most current deed.
Landowner 3 of Record:
LUMBEE TRIBE OF NORTH
CAROLINA
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 01505
Page No. 026 1 Provide a copy of the most current deed.
Landowner 4 of Record:
LOWERY RONNIE & WF, LOWERY ENDORIA
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip State Zip
Deed Book No.02131
GCity
Page No.OVOO Provide a copy of the most current deed.
Landowner 5 of Record:
JOHNSON MARCELENA, CHAVIS LF ES, LOWERY EARLENA,
REMAINDER
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 012G3
Page No. 0811 Provide a copy of the most current deed.

Continued from Item 1 in Part 8 of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Phone: Office # Mobile #
Company 3 Name
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Phone: Office # Mobile #
Company 4 Name
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City
Phone: Office # Mobile #
Company 5 Name
Current Mailing Address
E-mail Address
Current Street Address
State Zip
State Zip
State Zip
City State Zip City State Zip
Phone: Office # Mobile #

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
PAW DEVELOPERS LLC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State Zip
City State Zip
Deed Book No.02004 Page No. 051 O Provide a copy of the most current deed.
Landowner 3 of Record:
RANSOM VARDELL & WIFE LOLA
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State Zip
City State Zip
1720 O
189
Deed Book No. Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
KAYRON K MAYOR
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State Zip
City State Zip
1 887 0815
Deed Book No. Page No.
Provide a copy of the most current deed.
Landowner 5 of Record:
TOWN OF PEMBROKE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State Zip
City State Zip
Deed Book No. PIN (in Page No.) Page No.934318366000 Provide a copy of the most current deed

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
CHAVIS PERRY LYNN & LINDA 0
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
G �I
Deed Book No.00646
�I
Page No. 0435 Provide a copy of the most current deed.
Landowner 3 of Record:
CHAVIS BEN HENRY
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.0224 6
Page No. 01 97 Provide a copy of the most current deed.
Landowner 4 of Record:
PEMBROKE HOLDINGS COMPANY LLC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02231
Page No. 0570 Provide a copy of the most current deed.
Landowner 5 of Record:
FREEMAN WELDON &
URSULA
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 011 22
Page No. 0530 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page
as needed to list all landowners.
Landowner 2 of Record:
PLANTERS OIL COMPANY
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00871
Page No. 0G33 Provide a copy of the most current deed.
Landowner 3 of Record:
LOCKLEAR ERIC & WF, LOCKLEAR
KAREN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
Deed Book No. 02182
Page No. 021 V Provide a copy of the most current deed.
Landowner 4 of Record:
195 MINI MALL INCORPORATED
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02151
Page No. 0570 Provide a copy of the most current deed.
Landowner 5 of Record:
MERCER ALVIN
JOHN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 0212�I''
Page No. 0G30 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
HARRIS JAMES B JR & HARRIS
JOANN W
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.01029
Page No.0763 Provide a copy of the most current deed.
Landowner 3 of Record:
HARRIS JAMES B JR & HARRIS JOANN W
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00923
Page No. 00�I'' 1 Provide a copy of the most current deed.
Landowner 4 of Record:
HINSON SHERWOOD F
JR/WIFE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip State Zip
Deed Book No.00942
GCity
Page No.0637 Provide a copy of the most current deed.
Landowner 5 of Record:
LUMBEE GUARANTY
BANK
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. OOH7O
Page No. 0020 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
HUTCHINSON FAMILY INVESTMENTS LLC. C/O REAL
ESTATE TAX DEPT
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.0192�I''
Page No. 08�I'' 6 Provide a copy of the most current deed.
Landowner 3 of Record:
MALCOLM JOSHUA D & WF, MALCOLM MELORIA R
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.01670
Page No. 0288 Provide a copy of the most current deed.
Landowner 4 of Record:
LOWRY CRAIG & WF ELAINE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00684
�I'' 1 0 Provide a copy of the most current deed.
Page No. 0410
Landowner 5 of Record:
JOLICOEUR PAUL & WF JOLICOEUR CAROLINE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 02210
Page No. 06U6 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
LOCKLEAR BRADLEY MARSHALL
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02263
Page No. 036 1 Provide a copy of the most current deed.
Landowner 3 of Record:
SAMPSON WI LLI
E FAY
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00`�I 61
Page No. 0349 Provide a copy of the most current deed.
Landowner 4 of Record:
PAUL MARTHELMA, LF EST PAUL CAROL JEAN RE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State
State Zip
Deed Book No.00537
Page No.O�I''�I'''' Provide a copy of the most current deed.
Landowner 5 of Record:
FEDOR ELAINE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 01 059
Page No. 0G39 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
PAU L CAROL JEAN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.O 129�I''
Page No. 04 99 Provide a copy of the most current deed.
Landowner 3 of Record:
LOCKLEAR JAMES E & WF IRIS
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00S 1 O
Page No. 0023 Provide a copy of the most current deed.
Landowner 4 of Record:
LOCKLEAR IRIS
HUNT
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
1 OE
799
Deed Book No.
Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
OXENDINE JERRY C
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
Deed Book No. O 181 O
Page No. OU2 4 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
LOWERY JAN M
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip State Zip
Deed Book No.O 1 71 7
GC�Iity
Page No. 0647 Provide a copy of the most current deed.
Landowner 3 of Record:
DIAL ALLEN GRIFFIN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00403
Page No. 0141 Provide a copy of the most current deed.
Landowner 4 of Record:
BRAYBOY'S ENTERPRISES INC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. O 1 975
Page No. 0169 Provide a copy of the most current deed.
Landowner 5 of Record:
SAMPSON LINDA
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00756
Page No.0874 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
BELL SARAH S
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
Deed Book No.00783
Page No. 0256 Provide a copy of the most current deed.
Landowner 3 of Record:
RANSOM LOLA
M
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.0695
Page No. 0437 Provide a copy of the most current deed.
Landowner 4 of Record:
M&M PEMBROKE INVESTMENTS LLC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.01 734
Page No. 0305 Provide a copy of the most current deed.
Landowner 5 of Record:
PEMBERTON PLACE, INC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 021 OH
Page No. 0G97 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
PEMBERTON PLACE,
INC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
Deed Book No.02260
�I
Page No. 0414 Provide a copy of the most current deed.
Landowner 3 of Record:
COLLINS HAROLD
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
Deed Book No.00906
Page No.0876 Provide a copy of the most current deed.
Landowner 4 of Record:
OTTO STORES,
LLC
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.01 872
Page No. 07�I'' 5 Provide a copy of the most current deed.
Landowner 5 of Record:
SINGLETARY WADE III/WF DENISE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 010�I'' 5
Page No. 0335 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
LOCKLEAR EUGENE & WOODELL HARRELTON
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00H 1 7
Page No. 0225 Provide a copy of the most current deed.
Landowner 3 of Record:
DINKINS LINDA LF EST, LOCKLEAR MARVIN
FULLER JR
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02123
Page No. OH5O Provide a copy of the most current deed.
Landowner 4 of Record:
RANSOM CRESE
L
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
G
Deed Book No.00VOV
�I
Page No.0471 Provide a copy of the most current deed.
Landowner 5 of Record:
LOCKLEAR ARNOLD
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
State Zip
Zip City State
Deed Book No. OOH9O
Page No. 0�I'' 5'' Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page
as needed to list all landowners.
Landowner 2 of Record:
MERCER ALVIN
JOHN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
O 1822
TRACT 1
Deed Book No.
Page No.0482
Provide a copy of the most current deed.
Landowner 3 of Record:
MERCER ALVIN
JOHN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip State Zip
Deed Book No.O 1984
GCity
Page No.OVOO Provide a copy of the most current deed.
Landowner 4 of Record:
MERCER ALVIN
JOHN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
O 1822
TRACT 3
Deed Book No.
Page No.0482
Provide a copy of the most current deed.
Landowner 5 of Record:
OXENDINE BOBBY & WF OXENDINE
CAROLYN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 005G0
Page No. 000 1 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
OXENDINE HENRY WARD & OXENDINE BOBBY R & OTHERS
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02004
Page No. 0039 Provide a copy of the most current deed.
Landowner 3 of Record:
OXENDINE HARTLEY J &
FANNIE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. PL BK 20
Page No. 104 Provide a copy of the most current deed.
Landowner 4 of Record:
LOCKLEAR RHONDA SUE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
G
Deed Book No.00V9O
Page No.0739 Provide a copy of the most current deed.
Landowner 5 of Record:
LLOYD DARYL A DIAL DENISE
L
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
18E
O228
Deed Book No.
Page No. Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page
as needed to list all landowners.
Landowner 2 of Record:
LLOYD DARYL A DIAL DENISE L
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip CityState Zip
G �I
Deed Book No.00643
Page No. 0174 Provide a copy of the most current deed.
Landowner 3 of Record:
WOODS AARON
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.0217�I''
Page No. 0G27 Provide a copy of the most current deed.
Landowner 4 of Record:
LOCKLEAR EDDIE MAC, LOCKLEAR MARY
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.01705
Page No. 0024 Provide a copy of the most current deed.
Landowner 5 of Record:
THOMPSON NORMA JEAN LF EST THOMPSON VERL R REM
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 007 E
Page No. 0711 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
THOMPSON NORMA JEAN LF EST THOMPSON VERL R REM
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.00801
Page No. 05�I4 9 Provide a copy of the most current deed.
Landowner 3 of Record:
THOMPSON NORMA
JEAN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
00622
0253 TRACT 1 & 2
Deed Book No.
Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
CAMPBELL JENIFER & MARTIN JOHN
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No.02135
Page No. 0861 Provide a copy of the most current deed.
Landowner 5 of Record:
TOWN OF PEMBROKE
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip City State Zip
Deed Book No. 0135�I''
Page No. 0420 Provide a copy of the most current deed.

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Name
Phone:
Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City
State Zip
Deed Book No. O 1803
Page No. 025 4
Provide a copy of the most current deed.
Landowner 3 of Record:
Name
Phone:
Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City
State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
Name
Phone:
Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City
State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 5 of Record:
Name
Phone:
Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City
State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.