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Hom <br />CarF <br />patch <br />.. <br />avers <br />ATTACHMENT E <br />June 10, 2011 <br />Contract #68-2011 <br />FlairCare, Inc. <br />To: Orange County Department of Social Services <br />Certification: <br />We certify that FlairCare, Inc., dba Homewatch CareGivers of the Triangle 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. We further understand that <br />any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal <br />offense punishable as provided by N.C.G.S. 143C-10-1. <br />Sworn Statement: <br />Anzor Gachechiladze and Kimberly A. Flair being duly sworn, say that we are the Board Chair and <br />Secretary of the Board, respectively, of FlairCare, Inc., dba Homewatch CareGivers of the Triangle of <br />Chapel Hill in the State of North Carolina; and that the foregoing certification is true, accurate and <br />complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and <br />understand that any misuse of State funds will be reported to the appropriate authorities for further <br />action. <br />Q - <br />Anzor G echiladze, Board Chair <br />~u( •1 <br />Kimberly A. F r, Secretary of the Board <br />Sworn to and subscribed before me on the <br />OVERDUE TAXES <br />~~GOURrN'~~~. <br />~f the date o~~ajd~~rtification. <br />NO~ (1 <br />~~ <br />• ^/ <br />' J 9 y Commission Ex' es: ar(~ ~v ~y~ <br />~p ~? <br />(Notary n ture and Seal) ''~~~I~V~~ ~G`~~'~ <br />/I/U111N <br />homewatchcaregivers.com <br />001 LTHD <br />