NCC224200_FRO Submitted_20230104

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM (REV 21 April 2022)
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 City of
Archdale ACE Integrated Stormwater Management Program. Submit the completed form and current deed to
the appropriate personnel. (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.
Project Name: 300 Roelee Street - Proiect Red Oak
2. Location of land -disturbing activity: County: Randolph City or Township: Trinity
Highway/Street: Roelee Street Latitude(decimaldegrees�35.89460 Longitude (decimal degrees) -79.97359
3. Approximate date land -disturbing activity will commence: March 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas):17.5 acres
6. Amount of fee enclosed: $0 . The application fee is defined in the published City of
Archdale fee structure which is typically $0 when a Technical Review Committee (TRC) evaluation is
required. Checks should be addressed to City of Archdale.
7. Has an erosion and sediment control plan been filed? Yes ❑x Enclosed ❑ No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name: Anthony Parker E-mail Address: aparkera-crescentcommunties.com
Phone: Office #
Mobile # [phone]
Landowner(s) of Record (attach accompanied page to list additional owners):
CC SFA BTS, LLC
Name
601 S Tryon Street, Suite 800
Current Mailing Address
Charlotte NC 28202
City State Zip
Phone: Office # Mobile #
Current Street Address
City State Zip
10. Deed Book No. 2836 Page No. 1123, 1126-1132 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 company is 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).
Crescent Communities
Company Name
aparker(a)crescentcommunities.com
E-mail Address
601 S. Tryon St., Suite 300 601 S. Tryon St., Suite 300
Current Mailing Address Current Street Address
Charlotte NC 28202 Charlotte NC 28202
City State Zip City State Zip
Phone: Office #
Mobile # [phone]
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:
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:
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.
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.
Anthony A. Parker - Director of Development,
ype or print name
Signature
Crescent Acquisitions, LLC
Title or Authority
10/17/22
Date
I, 17X-2/ W , a Notary Public of the County of RLXZ 9
State of North Carolina, hereby certify that _4—h—Y-U& A Gr appeared personally
before me this day and being duly sworn ac/knowledg that theaboveform was executed by him/her.
Witness my hand and notarial seal, this / day of L�!!� 20�—
.y1jezz "/�- 4 4Z4��
Notary
My commission expires
TERI A. EDWARDS
Notary Public, North Carolina
Mecklenburg County
My Commission Expires
May 07, 2025