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DocuSign Envelope ID:3CFBBB39-06B3-4306-ADD8-CBC8E2B91CA9 <br /> Attachment E, <br /> Lesly Veronica Penick <br /> 221 Adams Street <br /> Cary, NC 27513 <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.0 G.S. 143-34(b) <br /> Sworn Statement: <br /> I, being duly sworn, say that I am Lesly Veronica Penick; 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 befbre me on the,-94 day of , 2015 <br /> My Commission Expites: <br /> `tart' Signature and Seal) <br /> CRYSTAL BELLE COBLE <br /> NOTARY PUBLIC <br /> ORANGE COUNTY <br /> NORTH CAROLINA <br />