NCC233238_FRO Submitted_20231030

CARY py
— NORTH CAROLINA —
Stormwater Division
FINANCIAL RESPONSIBILITY -OWNERSHIP FORM
No person may initiate any land-disturbing activity covered by Cary's Sedimentation and Erosion Control
Ordinance before completing and filing this form with the Cary Stormwater Division. Indicate N/A if a
question is not applicable.
Section 1
PROJECT NAME: Hidden Creek
PROJECT DEVELOPMENT PLAN#: 22-DP-4277
PROJECT LOCATION:
0724290433
Property Tax ID#/PIN
0 Yates Store Rd
Street Address
APPROXIMATE DATE OF PROJECT INITIATION: 09/2023
ACREAGE OF LAND TO BE DISTURBED. 18.80
APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2
of the Financial Responsibility/Ownership(FR/O) Form.)
Taylor Morrison of Carolinas, Inc.
Name(Person or Firm)
Section 2
PERSON(S)OR FIRM(S) FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY
(If out of state, a registered agent in North Carolina must be used.)
Taylor Morrison of Carolinas, Inc.
Name(Person or Firm)
15501 Weston Parkway, Suite 100
Street Address(No PO Box)
Cary, NC 27513
City State Zip
Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel:311 or 919-469-4000 outside Cary limits www.carvnc.gov
updated:04/2023

919-748-2421
Telephone Number
N/A
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE.
(If out of state, a registered agent in North Carolina must be used.)
Christian Sheppard
Name
15501 Weston Parkway, Suite 100
Street Address(No PO Box)
Cary, NC 27513
City State Zip
919-748-2421
Telephone Number
N/A
Fax Number
[e-mail]
E-Mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation. Please indicate your preference below
447-1-.4/L OR Christian Sheppard
Financially Responsible Person Registered Agent
Section 3
LANDOWNER OF RECORD:
Taylor Morrison of Carolinas, Inc.
Name(Person or Firm)
0724290433
Property Tax ID#/PIN
15501 Weston Parkway, Suite 100
Street Address(No PO Box)
Cary, NC 27513
City State Zip
Cary
316 North Academy Street, Cary, NC 27513 PO Box 8005, Cary, NC 27512-8005
Tel: 311 or 919-469-4000 outside Cary limits www.carync.gov
Page 2 of 3 updated:04/2023

STATEMENT OF LANDOWNER CONSENT:
In accordance with NCGS 113A-54.1(a), I hereby declare that I am the owner or legally authorized
representative of the owner of the property described above and provide my consent for the applicant
cited in Section 1 above to submit an erosion control plan to the Town of Cary Stormwater Division and to
conduct the planned land-disturbing activities on the property listed in Section 1 above.
Christian Sheppard Land Development Director
Name Title or Authority
r,/7,/,/leo *M'/`' 9/18/2023
Signature F/ Date
[e-mail] 919-748-2421
Email Telephone Number
THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided
by me while under oath. (This form must be signed by the financially responsible person, if an
individual or by an officer, director, partner, attorney-in-fact, or other person with authority to
execute instruments for the financially responsible person if not an individual.)
Christian Sheppard Land Development Director
Type or Print ame Title or Authority
y,,Lv — 9/18/2023
Signature D3"
I, / e S . a Notary Public of the County of c
State of North Carolina, he ebY certifies that Christian Sheppard
personally appeared before me this day and under oath acknowledged that the above form was
executed by him/her.
Witness my hand and notarial seal, this I day of }D-k',v, , 2l) 3
PAMELA 0 EPPS �
NOTARY PUBLIC Notary Public
WakeECpunty,North Carolina
My Commission Expires February 27,2028 7-
My commission expires e9,a
Cary
316 North Academy Street,Cary, NC 27513 PO Box 8005,Cary, NC 27512-8005
Tel:311 or 919-469-4000 outside Cary limits www.carync.gov
Page 3 of 3 updated:04/2023