NCC240046_FRO Submitted_20240108

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FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity covered by the Act before this form has been
completed and filed with the City of High Point Engineering Department.
Please type or print and, if question is not applicable, place N/A in the blank.
PART A.
1. Project Name EVOLVE at DEEP RIVER.
2. Location of land-disturbing activity: City I-IIGH POINT
Highway/Street PENNY ROAD.
3. Approximate date land-disturbing activity will commence: JULY 2023
4. Purpose of development (residential, commercial, industrial, etc.)
MULTI-FAMILY RESIDENTIAL
5. Approximate acreage of land to be disturbed or uncovered: 15.15 ACS.
6. Has an erosion and sedimentation control plan been filed? Yes X No
7. Landowner(s)of Record (use blank page to list additional owners):
MCFT HIGH POINT,LLC MPW HIGH POINT,LLC .
Name: Joseph A. McKinney,Jr Name:Michael P.Winstead,Jr
2918-A MARTINSVILLE RD 2918-A MARTINSVILLE RD .
Current Mailing Address Current Mailing Address
GREENSBORO,NC 27408 GREENSBORO, NC 27408 .
City, State, Zip City,State, Zip
336.544.6215 336.544.6215
Telephone Number Telephone Number
8. Indicate book and page where deed or instrument is filed (use blank page to list additional deeds
or instruments):
Book 8682 Page 2496 .
Book 8682 Page 2500
PART B.
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1. Person(s) or finn(s) who are financially responsible for this land-disturbing activity:
MCFT HIGH POINT, LLC . MPW HIGH POINT, LLC .
Name: Joseph A. McKinney, Jr Name: Michael P. Winstead, Jr
2918-A MARTINSVILLE RD 2918-A MARTINSVILLE RD .
Current Mailing Address Current Mailing Address
GREENSBORO, NC 27408 GREENSBORO, NC 27408 .
City, State, Zip City, State, Zip
336.544.6215 336.544.6215
Telephone Number Telephone Number
2. Registered agent, if any, for the person firm ho is in n lly responsible:
• f� `-� za e' -A J4.4.r;li$ Rd. -T,0i1oo�r-o),IVL 2-tWa1
Si na re Mailing Address
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Printed Name }Telephone Number
3. 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 if not an individual, by an officer, director,partner or attorney-in-fact, or registered
agent with 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.
Aic40-di ' AcIfv)
Type . a► e Lt/ Title of Authorit'
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S re dp to
I, A i e lie /a Notary Public of the C my Hew/-kaakitate of North
appeared personallybefore me
Carolina, do hereby certify that Oe f�MCl� j Kl�'Q(�/�i�(Q' /N ,�, pp
this day and being duly sworn acknowledged that the above fonn was executed by him.
Witness my hand and notarial seal, this 0‘l' day of � , 2013 .
Notary Pub1' .7 IG!%
PMa,O, My commission expires: ©�
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NEVER C ,, .
FinResFm. Page# 2