Orange County NC Website
Browse       Search
i <br /> 4 <br /> Exhibit E <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 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 me. I also acknowledge and understand that any misuse of State funds <br /> will be reported to the appropriate authorities for further action. <br /> -„, <br /> Ilk <br /> ‘, ..., • fai V , <br /> 1/4. •1/4-awsma ill m■ <br /> ..,Signature <br /> D13''''b <br /> Sworn to and subscribed before me on the day of, 5(.,.-..-., 2012. <br /> ) 7 ' / t <br /> ( <br /> ---- <br /> otary Signature and Seal) _ _ v1y Commission Expires: /6(OcV9-0 4...c <br /> ,00 EARL <br /> --4": <br /> oTivi• .c"7 <br /> : N4 <br /> . . <br /> WC4Wuso ..* <br /> "444,/iieo'Oe' <br />