Orange County NC Website
DocuSign Envelope ID:6D70782A-BD9D-4DD3-AC4C-748221592134 <br /> Exhibit E <br /> Marianela Manana <br /> 12034 Chase Crossing Circle <br /> Apartment##203 <br /> North Bethesda,MD 20852 <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 farther 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 C.G.S. 143-34(b) <br /> Sworn Statement: <br /> I, being duly sworn, say that I am Marianela Manana; and that the foregoing certification <br /> is true, accurate and complete to the best of'rny knowledge and was made and subscribed <br /> by me, I also acknowledge and understand that any misuse of State funds will be <br /> reported to the appropriate authorities for further action. <br /> A <br /> ignature <br /> f� <br /> Sworn to and subscribed before me on the i `� day of 5 , 2015. <br /> Z My Commission Expires: cal j� ''Zvr7 <br /> Signature and Seal) <br /> ERIC DAN LEE <br /> Notary Public <br /> Maritgomery County <br /> Maryland <br /> My Commission Expires January 15, 2017 <br />