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June 28, 2011 <br />Helene Montgomery <br />112 Boulder Lane <br />Chapel Hill, NC 27514 <br />To: Orange County Department of Social Services <br />Certification: <br />I certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at <br />the federal, State, or local level. I further understand that any person who makes a false <br />statement in violation of N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable <br />as provided by N.C.G.S. 143-34(b). <br />Sworn Statement: <br />I, being duly sworn, say that I am Helene Ramos Montgomery and that the foregoing <br />certification is true, accurate and complete to the best of my knowledge and was made <br />and subscribed by 1~~also acknowledge and understand that any misuse of State funds <br />will be r`e(p~orted to he pp riat authorities for further action. <br />< < 1 V~~... .. <br />Sworn to and subscribed before me on the oZ~~ day of ~, 2011. <br />~'~~,~ My Commission Expires: (, ~ y ~,1 ~-c3i S <br />Signature and <br />~~.~~ CJ's; ~' • VA'' <br />_.. _.- <br />!`~' <br />. ~:'~Mc~..aF~~ <br />