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Contract 068-2001 <br /> I lolcomb and Cabe.L.L.P. <br /> ATTACHMENT E <br /> OVERDUE:TAXES <br /> Orange County Department of Social Services <br /> Instructions: Grantee/Provider should complete this certification For all funds received. Entity <br /> should enter appropriate data in the yellow highlighted areas. The completed and signed form <br /> must be provided to the County Department of Social Services. <br /> Entity's Letterhead <br /> Date of Certification(mmddyyyy)l <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that the [insert organization's name) 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. 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 <br /> criminal offense punishable as provided by N.C.G,S. 143C-10-1(b). <br /> Sworn Statement: <br /> [Name of Board Chair]and[Name of Second Authorizing Official] being duly sworn,say that we <br /> are the Board Chair and[Title of the Second Authorizing Official], respectively,of[insert name <br /> of organization]of[City] in the State of[Name of State];and that the foregoing certification is <br /> true, accurate and complete to the best of our knowledge and was made and subscribed by us. <br /> We also acknowledge and understand that any suse of State funds will be reported to the <br /> appropriat uthon ies for f her action. <br /> Q <br /> oard Chair <br /> [Title of Second Authorizing Official] <br /> Sworn to and subscribed before me on.l ay-efto date.,of said certification. <br /> ,'�'?•` A, <br /> OV '?�"�9�'=: <br /> 1 My Cortission Expires: J7 1C+f� <br /> ( <br /> tar-y-Si nature and Seal) .0 , ; <br /> .�4• •,fig~:,, ,�.�•,,, <br /> . tiG� •CO�C� ''• <br /> G.S.105-243.1 defines:Overdue tax debt. Any part of•a tax debt that remains unpaid 90 clays or more alter the <br /> notice of final assessment was mailed to the taxpayer.The term does not include a tax debt,however.if the taxpayer <br /> entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final <br /> assessment was mailed and has not failed to make any payments due under the installment agreement." <br /> Overdue'faxes--(07/08) Page I off <br />