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DocuSign Envelope ID:2D2D4024-9587-4AD4-BF9B-91 E3244EA302 <br /> Attachment E <br /> Naw Paw Hser(Ken Ket) <br /> 306 Estes Drive, Apartment C-12 <br /> Carrboro,NC 27510 <br /> 7o: 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 GS 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 Naw Paw Hser (Ken Ket); and that the foregoing <br /> certification is true, accurate and complete to the best of my knowledge and was made <br /> and subscribed by me I also acknowledge and understand that any misuse of State funds <br /> will be reported to the appropriate authorities for further action. <br /> Signature <br /> Sworn to and subscribed before me on theQ--1 day of 2015. <br /> M Commission Ex ices: <br /> � y p <br /> U otary Signature and Seal) <br /> CRYSTAL BELLE COBLE <br /> NOTARY PUBLIC <br /> ORANGE COUNTY <br /> NORTH ECAIlOLINA <br />