NCC224172_FRO Submitted_20221221

°� Gaston County
if Gaston Natural Resources Department
8 1303 Cherryville Highway, Dallas, NC 28034 Telephone: [phone]
6fanea;� Soil Erosion & Sedimentation Control
- Financial Responsibility/Ownership
No person may initiate any land -disturbing activity on one (1) or more acres of property in all portions of
Gaston County, except for that property within the city limits of the incorporated municipalities of Gaston
County who have not adopted the Gaston County Soil Erosion & Sedimentation Control Ordinance,
before this form and an acceptable Soil Erosion & Sedimentation Control Plan have been completed and
approved by the Gaston County Natural Resources Department's staff.
(Please type or print and, if question is not applicable, place NIA in blank)
PART A:
1. Project Name Kamdar Industries Warehouse Expansion
2. Location of land -disturbing activity
City Gastonia Highway/Street Old York Road
3. Approximate date land -disturbing activity will commence December, 2022
4. Purpose of development (residential, commercial, industrial, etc.) Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas) 3.07 acres
6. Amount of fee enclosed $ 300 x 4.00ac = $1,200,00
7. Soil Erosion & Sedimentation Plan Filed? Yes enclosedNo
8. Landowner(s) of Record (Use blank page to list additional owners)
E
10
AMA Lucky Group Investment LLC
Name
3500 Old York Road
Mailing Address
Gastonia NC 28056
City State Zip
704 860 3838
Telephone Number
AMA Lucky Group Investment LLC
Name
3500 Old York Road
Mailing Address
Gastonia NC 28056
City State Zip
704 860 3838
Telephone Number
Indicate Deed Book and Page where deed(s) or instrument(s) are recorded
Deed Book 4896 Page 1073
Deed Book Page
Tax Map No. 3544303104 Block
IWST40 M
Page I

PART B:
1. Person(s) or firm(s) who are financially responsible for this property.
Masood Kamdar
Name
3500 Old York Road
Mailing Address
Gastonia NC 28056
City State Zip
7048603838
Telephone Number
Kamran Mumtaz
Contact Name for Inspection Reports
[e-mail]
Email Address
704-506-1122
Telephone Number
Fax Number
2. if the Financially Responsible Party is not a resident of North Carolina, give name and street
address of a North Carolina agent.
Name
Mailing Address Street Address
City State zip Telephone Number
If the Financially Responsible Party is a Partnership or other person engaging in business under
an assumed name, attach a copy of the certificate of assumed name. If the Financially
Responsible Part is a Corporation give name and street address of the Registered Agent.
Name
Mailing Address Street Address
City State Zip Telephone Number
4. 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 or his attorney -in -fact, or, if not an individual, by an officer, director, partner, or
registered agent with authority to execute instruments for the financially responsible person). I
agree to provide corrected information should there be any change in the information provided
herein.
T p r Print Name Title or Authority
nature Date
I, Y�'1[ATTY�W
IALAAA a Notary Public of the County of GA-4-1 State of North
Caroli a, hereby certify that N1As a,71Q ICr, .�a� appeared personally before me this day
and being duly sworn acknowledged that the above form was executed by him.
`Witness my
hand and notarial seal, this Li day of Oc -taW-c' ,120 2-7
Notary SEAL My Commission Expires
File: Financial Responsibility -Ownership Form.mw
MATTHEW TADAMS
Notary Public - North Carolina
Gaston County
My Commission Expires Nov 29, 2025
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