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Attachment E <br /> Thein Tun Zan <br /> 114 Phoenix Drive <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 /> 1, being duly sworn, say that I am Thein Tun Zan; 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 thec�+ day of 2014. <br /> wa;j" r4k - My Commission Expires: <br /> (No y Signature and Seal)-- <br /> CRYSTAL BELLE COBLE <br /> NOTARY PUBLIC <br /> ORANGE COUNTY <br /> NORTH CAROLINA <br />