NCC232814_FRO Submitted_20230920

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
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 Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (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.
1. Project Name McPherson Crossing
2. Location of land-disturbing activity: County Cumberland City or Township Fayetteville
McPherson Church 35.045513 -78.936154
Highway/Street Latitude(decimai degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing acts.ity will commence: 12/26/2002
4. Purpose of development(residential, commercial, industrial, institutional, etc.): commercial
5. Total acreage disturbed or .incovered (including off-site borrow and waste areas): 3.33
6. Amount of fee enclosed: $400.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Examclle: 8.10-acre application fee is$900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes❑x Enclosed ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Ralph Huff E-mail Address [e-mail]
Phone: Office# 910-751-3255 Mobile#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
RALPH HUFF FAMILY LIMITED PARTNERSHIP 910-751-3255
Name Phone: Office# Mobile#
2919 Breezewood Avenue, Suite 100 2919 Breezewood Avenue, Suite 100
Current Mailing Address Current Street Address
Fayetteville NC 28303 Fayetteville NC 28303
City State Zip City State Zip
10. Deed Book No. 7414 Page No. 0134 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 or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
RALPH HUFF FAMILY LIMITED PARTNERSHIP [e-mail]
Company Name E-mail Address
2919 Breezewood Avenue, Suite 100 2919 Breezewood Ave, Suite 100
Current Mailing Address Current Street Address
Fayetteville NC 28303 Fayetteville NC 28303
City State Zip City State Zip
Phone: Office# 910-302-3608 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.
B . . •h Huff Ill Manager-RALPH HUFF FAMILY LIMITED PARTNERSHIP
se or int Title or Authority
12/16/22
Date
Jill Riley , a Notary Public of the County of Cumberland
State of North Carolina, h- eby certify that D. Ralph Huff Ill appeared personally
before me this day and bein duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial • eal, this 16 day of December 20 2022
0000 wok,.
5\0-
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NOTA
II
Ay � Not.
Seal
GCOMMISSION EXPIRES My commission expires August 3, 2025
8/3/202b
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O '�UBLUC �.�c

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
PURDUE COMMONS INC 910-302-3608
Name Phone: Office# Mobile#
2919 Breezewood Avenue, Suite 100 2919 Breezewood Avenue, Suite 100
Current Mailing Address Current Street Address
Fayetteville, NC 28303 Fayetteville, NC 28303
City State Zip City State Zip
0Deed Book No.7414 Page No. 134 Provide a copy of the most current deed.
Landowner 3 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.

Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#