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DocuSign Envelope ID:BD69DF46-15CD-49E6-8588-93617FCCFB94 <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 /> ' i1 <br /> 4 <br /> Chatham Transit Network <br /> Pia Box |uaz <br /> Pioshom.NCJ7312 <br /> (Date nf Certification(07l82016)l <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 <br /> by N.C. 3. \O5'243.1/, o1dhe6mdora[ Stutu, or |oca! |evni We further understand that any <br /> person who makes a false statement in violation of N.C.G.S. 143[-6-23(c) is guilty of a criminal <br /> offense punishable as provided by N.C.G.S. 143C-l0'l(b). <br /> Sworn Statement: <br /> Tim Mounce and Anna Testerman being duly sworn,say that we are the Board Chair and the <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 /> mism .�ndo will bercpo�ed tn the appropriate uuthohhesfor further acbon. <br /> - - �� �.� <br /> - �` / \ �� ` <br /> w ` <br /> Board hair jcs <br /> Executive Director <br /> Sworn to and subscribed befor me on the day of the date of said certification. <br /> 010. My Commission Expires: Od 44 |�� <br /> � � <br /> Deborah H.Brown <br /> Notary Public <br /> Lee County,North Carolina <br /> G.S. 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 tax debt,however,if the taxpayer <br /> entered into an installment agreement for the tax debt under 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 thc installment agreement." <br /> �ago � nf| <br /> O���T�m- 0�80 <br />