NCC232806_FRO Submitted_20230926

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
EROSION & SEDIMENTATION CONTROL
IREDELLNo person may initiate any land-disturbing activity on one or more acres, '/2 acre or more inside a
COUNTY NC watershed, as covered by the Sedimentation Pollution Control Act and the Iredell County Land
Development Code, before an acceptable erosion and sedimentation control plan has been submitted
and approved by the Iredell County Planning&Development, Erosion Control Section.
(Please type or print.)
Part A.
1. Project Name Brawley Crossing - Outparcel 5
2. Location of land-disturbing activity: County Iredell City or Township Mooresville
Highway/Street Talbert Road Latitude N 35-35-02 Longitude W 80-51-08
3. Approximate date land-disturbing activity will commence: Spring 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.2 Ac.
6. Amount of fee enclosed: $ 525 . 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 0.5 acres but no
greater than 0.99 acres in a water supply watershed, a flat fee of$135.00 is assessed.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Don Horton E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
HDC-Brawley-Mooresville Partners, L.P. [phone]
Name Telephone Fax Number
12335 Kingside Lane, Suite 280 Talbert Road
Current Mailing Address Current Street Address
Houston Texas 77024 Mooresville NC 28117
City State Zip City State Zip
10. Deed Book No. 2555 Page No. 637 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):
HDC-Brawley-Mooresville Partners LP [e-mail]
Name E-mail Address
12335 Kingside Lane, Ste. 280 12335 Kingside Lane, Ste. 280
Current Mailing Address Current Street Address
Houston, TX 77024 Houston, TX 77024
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:
Don Horton [e-mail]
Name E-mail Address
1094 Landon's Court 1094 Landon's Court
Current Mailing Address Current Street Address
China Grove NC 28023 China Grove NC 28023
City State Zip City State Zip
Telephone [phone] Fax Number [phone]
(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:
Key Kasravi [e-mail]
Name of Registered Agent E-mail Address
12335 Kingside Lane, Ste. 280 12335 Kingside Lane, Ste. 280
Current Mailing Address Current Street Address
Houston, TX 77024 Houston, TX 77024
City State Zip City State Zip
Telephone [phone] 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.
Kiavash Kasravi Principal
Type or print name Title or Authority
12/20/2022
Signature Date
I, Judson Martin , a Notary Public of the County of Harris,
State of Texas, hereby certify that Kiavash Kasravi 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 20th day of December , 2022
Seal p\ YpUa� JkiDSONJAMARTIN
Notary
a 1,1a ID#128952980
s,.�t My Commission Expires My commission expires
41For April 12,2024
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