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June 27, 2011 <br />Saw San Mya <br />110 Fan Branch Lane <br />Chapel Hill, NC 27516 <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 Saw San Mya; and that the foregoing certification is <br />true, accurate and complete to the best of my knowledge and was made and subscribed by <br />me. I also acknowledge and understand that any misuse of State funds will be reported to <br />the appropriate authorities for further action. <br />Signature <br />Sworn to and subscribed before me on the ~ ~ day of ~ ~-°-- , 2011. <br />v My Commission Expires: l b C pq ~ 10 l,S` <br />otary Signature and S 1) <br />~~;~`~ <br />~~ , <br />.~ .. <br />