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DocuSign Envelope ID:36A1758E-5364-41`8C-9594-955423313131D4 <br /> Attachment E <br /> Saw San Mya <br /> I10 Fan Branch Lane <br /> Chapel Hill, NC 27516 <br /> Io: 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.0 G.S 143-6 2(b2) is guilty of'a criminal offense punishable <br /> as provided by MC„G S 143-34(b). <br /> Sworn Statement: <br /> I, being duly sworn, say. that I am Saw San Mya; and that the foregoing certification is <br /> true, accurate and complete to the best of'my knowledge and was made and subscribed by <br /> me. I also acknowledge and understand that any misuse of State funds will be reported to <br /> the appropriate authorities for further action <br /> Signature <br /> r <br /> 1 <br /> Sworn to and subscribed before me on the day of (P, 2015 <br /> My Commission Expires: <br /> (No; y Si—gnat and Seal) <br /> CRYSTAL BE COBLE <br /> NOTARY PUBLIC <br /> ORANGE COUNTY <br /> NORTH CAROLINA <br />