Orange County NC Website
Browse       Search
Contract #68-2004 <br />Personalized Patient Home Assistance, Inc. <br />ATTAC)EEVIENT E <br />OVERDUE TAXES <br />Orange County Department of Social Services <br />June 21, 2007 <br />To: Orange County Department of Social Services <br />Certification: <br />I certify that Personalized Patient Home Assistance, Inc. does not have any overdue tax <br />debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I further <br />understand that any person who makes a false statement in violation of N.C.G.S. 143- <br />6.2(b2) is guilty of a criminal offense punishable as provided by N.C.G.S. 143-34(b). <br />Sworn Statement: <br />~~~~~• ~l(~~~1~' ~be~n dul sworn, say that I am the ~`~`{~ ~ , <br />g Y <br />of Personalized Patient Home Assistance, Inc. of Chapel Hill in the State of North <br />Carolina; and that the foregoing certification is true, accurate and complete to the best of <br />i my knowledge and was made and subscribed by me. I also acknowledge and understand <br />that any misuse of State funds will be reported to the appropriate authorities for further <br />action. <br />Director _.. <br />Sworn to and subscribed before me on the day of the date of said certification. <br />' / ~ M Commission Ex fires: /~~~ <br />Y P <br />(Notary Signature and Seal) <br />• <br />Overdue Taxes - (06/04) Page 1 of 1 <br />