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DocuSign Envelope ID:9B933134-7684-4CD8-A56F-54DAC106A444 <br /> Attachment E <br /> Naw Paw Hser(Ken Ket) <br /> 306 Estes Drive, Apartment C-12 <br /> Carrboro,NC 27510 <br /> ti <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.C.G.S. 143-34(b). <br /> Sworn Statement: <br /> I, being duly sworn, say that I am Naw Paw Hser; 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 /> VI <br /> r <br /> E <br /> Signature <br /> Sworn to and subscribed before me on theCY day of I1 e-,, 2016. <br /> ii <br /> G il ' , My Commission Expires: l(— /3f <br /> (Notary Signa re and Seal) <br /> CRYSTAL BELLE COBLE <br /> NOTARY PUBLIC <br /> ORANGE COUNTY <br /> NORTH CAROLINA <br />