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20 <br />Contract #68 -2005 <br />Arcadia Health Services, Inc. <br />ATTACHMENT E <br />OVERDUE TAXES <br />Orange County Department of Social Services and Orange County Department on Aging <br />, 2010 <br />To: Orange County Department of Social Services and Orange County Department on <br />Aging <br />Certification: <br />I certify that Arcadia Health Services, Inc. does not have any overdue tax debts, as <br />defined by N.C.G.S. 105- 243.1, at the federal, State, or local level. I further understand <br />that any person who makes a false statement in violation of N.C.G.S. 143- 6.2(b2) is <br />guilty of a criminal offense punishable as provided by N.C.G.S. 143- 34(b). <br />Sworn Statement: <br />, being duly sworn, say that I am the of <br />Arcadia Health Services, Inc. of in the State of North Carolina; and that the foregoing <br />certification is true, accurate and complete to the best of my knowledge and was made <br />and subscribed by me. I also acknowledge and understand that any misuse of State funds <br />will be reported to the appropriate authorities for further action. <br />Director <br />Sworn to and subscribed before me on the day of the date of said certification. <br />My Commission Expires: <br />(Notary Signature and Seal) <br />Overdue Taxes — (06/04) Page I of 1 <br />