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DocuSign Envelope ID:27BE0809-07F1-4358-A397-lF35DD236252 <br /> CHARLES HOUSE ASSOCIATION <br /> Helping People Age the Way They Have Lived <br /> June 10, 2015 <br /> To: Orange Count Department of Social Services <br /> County <br /> Seniors and Their <br /> Families Since 1990 <br /> Certification: <br /> Enriching the lives ofseniors We certify that Charles House Association does not have any overdue tax <br /> Suppotbngfamillescanngfor debts, as defined by N.C.G. 165-243.1, at the federal, state, or local level. We <br /> aging farnllymen�bers <br /> Represen faml ecommunity's further understand that any person who makes a false statement in violation of <br /> commitment to its elders N.C.G.S. 143-6-23(c) is guilty of a criminal offense punishable as provided by <br /> N.C.G.S. 143C-10-1. <br /> BOARD OF DIRECTORS <br /> Luke Riggsbee and Paul Klever, being duly sworn, say that we are the Board <br /> PRESIDENT President and Executive Director, respectively, of Charles House Association <br /> Luke Riggsbee of Carrboro, in the state of North Carolina; and that the foregoing certification <br /> VICE PRESIDENT is true, accurate and complete to the best of our knowledge and was made and <br /> Norman Klase subscribed by us. We also acknowledge and understand that any misuse of <br /> State funds will be reported to the appropriate authorities for further action. <br /> SECRETARY <br /> Sheana Funkhouser <br /> TREASURER <br /> Bradley Fox Board ident <br /> Michael Bradley Executive Director <br /> Phyliss Craig-Taylor <br /> Patty Hill <br /> Michael Hill Sworn to and subscribed before me on the day of the date of said certification. <br /> Melvin Hurston <br /> ,ferry Salak <br /> Cindy Skocik <br /> Tatnmie Stanton <br /> Sheryl Zimmerman Nat y Signature and Seal MEREDITH T GAUGHRAN <br /> NOTARY PUBLIC <br /> DURHAM COUNTY,NC <br /> EXECUTIVE f4 Commission Expires 9-28-2M6 <br /> DIRECTOR My Commission Expires: Vi <br /> Paul Klever <br /> paul@charieshouse.org <br /> G.S. I05-243.1 defines:Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more <br /> after the notice of final assessment was mailed to the taxpayer.The term does not include a tax debt, <br /> however,if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within <br /> 90 days after the notice of final assessment was mailed and has not failed to make any payments due <br /> under the installment agreement. <br /> 109 Hiilcrest Avenue, Carrboro, NC 27510 T (919) 967-7570 <br />