NCC222064_Contact Update Record (Leg Resp Change)_20230601

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 6/1/2023 3:01:54 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Prior Rescission Date This field will populate only if COC has already been rescinded.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
C) Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Jennifer Lampman
Individual(Previous)
First Name(New)* Alexis
Last Name(New)* DunFee
NEW Legally Reflects any revisions above
Responsible Alexis DunFee
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 160 West Main Street,#200, New Albany,OH
Address(Previous) 43054-1117
NEW Permittee 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 us
Permittee Street 160 West Main Street,#200, New Albany,OH
Address(Previous) 43054-1117
NEW Permittee Street Street Address
Address* 160 West Main Street
Address Line 2
Suite 200
City State/Province/Region
New Albany OH
Postal/Zip Code Country
43054 us
Change Requested Jake Gill(Development Manager)via email on 5/30/2023(Leg Resp Indiv Change
by:* form provided)
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 06/01/2023