Orange County NC Website
Browse       Search
DocuSign Envelope ID: FCE3F262-3C43-41 B8-BOB7-AE5E9684B477 <br /> Contract#68-2021 <br /> Vantage Care&Staffing,L.L.C. <br /> ATTACHMENT E <br /> OVERDUE TAXES <br /> Orange County Department of Social Services and Orange County Department on Aging <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 /> ANTAGE CARE & STAFFING, LLC <br /> 1112 Pebble Creek Crossing <br /> Durham, North Carolina 27713 <br /> TELEPHONE: 919-638-9456 FACSIMILE: 919-667-1563 <br /> Jun�015 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that the trr G�artg, =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-I(b). <br /> Sworn Statement: <br /> Mildred Akachukwu being duly sworn, say that I am the Agency Director of Vantage Care& <br /> Staffing, LLC of Durham in the State of North Carolina and that the foregoing certification is <br /> true,accurate and complete to the best of my knowledge and was made and subscribed by me. I <br /> also acknowled a and understand that any misuse of State funds will be reported to the <br /> appropria aut ities for further action. � oo <br /> Agency for V� TA a <br /> _z �,o R� = <br /> - <br /> - <br /> "°Jl cl v <br /> G.S. 105-243.1 defines:Overdue tax debt.—Any part of a tax debt that rem ari W 90 days o or er the <br /> notice of final assessment was mailed to the taxpayer.The term does not include i ?te taxpayer <br /> entered into an installment agreement for the tax debt under G.S. 105-237 within 9 ice of final <br /> assessment was mailed and has not failed to make any payments due under the installment agreement." <br /> Overdue Taxes—(07108) Page 1 of 2 <br />