NCC231495_FRO Submitted_20230516

1I [I ) _I_I_
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres, Y2 acre or more Inside a watershed, as covered by the
Sedimentation Pollution Control Act and the Iredell County Land Development Code, before this form and an acceptable erasion
and sedimentation control plan have been submitted and approved by the Iredell County Development Services,Planning Division-
Erosion Control Section. (Please type or print.)
Part A.
1. Project Name TRUMP NATIONAL GOLF COURSE- Pickleball Courts
2. Location of land-disturbing activity: County IREDELL City or Township N/A
Highway/Street Brawley School Latitude 35.520492 Longitude -80.929896
3. Approximate date land-disturbing activity will commence: 4-30-23
4. Purpose of development(residential,commercial, industrial, institutional,etc.): Recreational Plckleball
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas): 1.56
6. Amount of fee enclosed:$ 350.00 . An application fee of$175.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount(Example: a 9-acre application fee is$1575). For projects>than.5 acre but< 1.0 acre
in a water supply watershed,a fiat fee of$135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
James Sowers [e-mail]
Name E-mail Address
Telephone [phone] Cell# 704-363-7406 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
TNGC Charlotte, LLC 704-954-8521
Name Telephone Fax Number
120 Trump Square
Current Mailing Address Current Street Address
Mooresville, NC 28117
City State Zip City State Zip
10. Deed Book No. 2168 Page No. 1361 Provide a copy of the most current deed.
Part B.
1. Person(s)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive list of all
responsible parties on an attached sheet)
TNGC Charlotte, LLC [e-mail]
Name E-mail Address
120 Trump Square
Current Mailing Address Current Street Address
Mooresville, NC 28117
City State Zip City State Zip
Telephone [phone] Fax Number
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2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated
North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b)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 Party is a Corporation, 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
Telephone Fax Number
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 the authority to execute Instruments for the Financially Responsible Person). I agree to
provide corrected Information should there by any change in the information provided herein.
James Sowers GC Superintendent
Type or ame Title r Authority
7-7,(--" 15/ / 6--/,te c.2i
Sig a ure /re-"- Date
1, 4.4 d1-. 044ete , a Notary Public of the County of Tre.c10.11
State of North Carolina, hereby certify that TGp.%,s . t:.4erl 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 /ll day of cl 1 ,20 23
PEYTON WOODY � w, �` d a.
SeM0ARY PUBLIC Notary
!rode!!County My commission expires � /7 J62r
North Carolina r
My Commission Expires
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