Orange County NC Website
Browse       Search
DocuSign Envelope ID: EAAlB08E-4226-45A4-818B-A35B979DD90C <br /> Contract#63-2014 <br /> Senior Care of Orange County, Inc. <br /> ATTACHMENT <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 /> Florence Cray Soltys Adult Day Health Program <br /> Operated by: Senior Care of Orange Coutrty,lite. <br /> 105 Meadowland Drive <br /> Hillsborough,North Carolina 27278 <br /> 06124/2015 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that the Senior Care of Orange County; Inn does not have any overdue tax debts,as <br /> defined by N.C.G.S. 105-243.11, 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. 1430-6-23(c) is guilty of a <br /> criminal offense punishable as provided by N.C.G.S. 1430-10-1(b), <br /> Sworn Statement: <br /> John Hammond and David Wilkerson] being duly sworn, say that we are the Board Chair and <br /> Treasurer,respectively,of Senior Care of Orange County; Inc of Hillsborough in the State of <br /> North Carolina; and that the foregoing certification is true,accurate and complete to the best of <br /> our knowledge and was made and subscribed by its. We also acknowledge and understand that <br /> any misuse of State funds Will be Deported to the appropriate authorities foi-further action. <br /> N E 0�+4,1; <br /> a •d Ch e 0 <br /> AUBOG =s <br /> Sworn to and subscribed before me on the day of the date of said certification. +'•�''4 \3 <br /> SCE GO0 <br /> "fill <br /> #� t t yr My Commission Expires:�����k ao <br /> otary dignature and Seat) <br /> t G.S. 105-243.1 defines:Overdue t;tx debt_—Any part of a tax debt that remains unpaid 90 days or more after the <br /> notice oftinal assessment was mailed to Elie taxpayer.The term does not include a tax debt,however,if the taxpayer <br /> entered into an installment agreern4mL for the tax debt under G.S. 105-237 within 90 days after the notice of fina[ <br /> assessment was mailed pd has not failed to make any payments due under the installment agreement." <br /> Overdue Taxes--(07108) Page I of l <br />