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DocuSign Envelope ID: 55869249-D071-43C6-B9B7-126B43EDD48D <br /> Contract#68-2030 <br /> Chatham Transit Network <br /> ATTACHMENT E <br /> OVERDUE TAXES <br /> Orange County Department of Social Services <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 /> Transit <br /> Chatham Transit Network <br /> P,O.Box 1032 <br /> Pittsboro,NC 27312 <br /> 01292016 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that the Chatham Transit Network does not have any overdue tax debts,as defined by <br /> N.C,G.S. 105-243.1', at the federal, State, or local level. We further understand that any person <br /> who makes a false statement in violation of N.C.G.S. 1430-6-23(c) is guilty of a criminal offense <br /> punishable as provided by N,C.G.S. 1430-10-1(b). <br /> Sworn Statement: <br /> Tim Mounce and Anna,resterman being duly sworn, say that we are the Board Chair and <br /> Executive Director, respectively, of Chatham Transit Network of Pittsboro in the State of North <br /> Carolina;and that the foregoing certification is true,accurate and complete to the best of our <br /> knowledge and was made and subscribed by us. We also acknowledge and understand that any <br /> misuse of State funds will be reported to the appropriate authorities for further action. <br /> Boar Chair <br /> xec five Director <br /> Sworn to and subscribed before me on the day of the date of said certification. <br /> My Commission Expires: <br /> (N <br /> 61021 I MvIdN9 u011 u"U 3 <br /> "usloilo 4144"(JunoD 2WI <br /> '1!11qnd AMON <br /> umals'm qwoqoa <br /> QS. 105-243.1 defines:Overdue tax debt.-Any part of a tax debt that remains unpaid 90 days or more after the <br /> notice of final assessment was mailed to the taxpayer.The term does not include a tax debt,however, if the taxpayer <br /> entered into an installment agreement for the tax debt tinder G.S. 105-237 within 90 days after the notice of final <br /> assessment was mailed and has not failed to make any payments due under the installment agreement." <br /> Overdue Taxes-(07/08) Page I of I <br />