NCC222064_Contact Update Record_20230526

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/26/2023 12:08:00 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC222064
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-2064
Original NOI No.* 93192
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Oak View at Siler City, LLC
Project Name Oak View at Siler City
Address 226 Campus Drive,Siler City, NC
County Chatham
Latitude 35.7235
Longitude -79.4158
Date COC Issued* 06/03/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? Q No
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 919-609-3352
NEW Billing [phone]
Telephone No. (optional)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jennifer Lampman
(Previous)
Site Contact Title VP
(Previous)

Organization Oak View at Siler City, LLC
(Previous)
First Name(New)* Jake
Last Name(New)* Gill
NEW Site Contact* Reflects any revisions above
Jake Gill
NEW Site Contact Development Manager
Title
NEW Organization Oak View at Siler City, LLC
This field is not required on the NOI form and may not pre-populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 919-609-3352
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 160 West Main Street,#200, New Albany,OH
Address(Previous) 43054-1117
NEW Site Contact Street Address
Mailing Address* 160 West Main Street
Address Line 2
Suite 200
City State/Province/Region
New Albany OH
Postal/Zip Code Country
43054-1117 US
Change Requested Jake Gill via email on 5/26/2023.Jennifer Lampman is no longer with Wallick; legally
by:* responsible change form from Jake pending. Updates to billing and site contact
made in preparation for June invoices.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/26/2023