NCC230264_FRO Submitted (3)_20230130

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.
Brian Parmenter
Type or print name
nature
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Owner
Title or Authority
1 /12/20
Date
a Notary Public of the County of oc )�a.X rus
State of North Carolina, hereby certify that 7:?:)e i r�r� �`Gx -u- appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this /_day of 20
01111111/11
Notary
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v _ My commission expires
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