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DocuSign Envelope ID: 51CB0066-1185-4FDA-AC7B-8C1F27F6013F <br /> 1 ) 4, CHARLES HOUSE ASSOCIATION <br /> ' -,,,,:f - Yi, <br /> Helping people age the way they have lived <br /> 4 i, '6'''0'4' ""''(''0 July 13, 2016 <br /> ,r'hiu i 1 <br /> To: Orange County Department of Social Services <br /> Serving Seniors and Their <br /> Families Since 1990 <br /> Certification: <br /> Enriching the lives of senioi s <br /> We certify that Charles House Association does not have any overdue tax <br /> Supporting families caring for <br /> debts, as defined by N.C.G. 105-243.1, at the federal, state, or local level. We <br /> aging family member <br /> further understand that any person who makes a false statement in violation of <br /> Representing the community's <br /> commitment to its elder N.C.G.S. 143-6-23(e) is guilty of a criminal offense punishable as provided by <br /> N.C.G.S. 143C-10-1. <br /> BOARD OF DIRECTORS <br /> Melvin liurston and Paul Klever, being duly sworn, say that we are the Board <br /> PRESIDENT President and Executive Director, respectively, of Charles House Association <br /> Melvin Flurston of Carrboro, in the state of North Carolina; and that the foregoing certification <br /> VICE PRESIDENT is true, accurate and complete to the best of our knowledge and was made and <br /> Sheryl Zimmerman subscribed by us. We also acknowledge and understand that any misuse of <br /> State funds will be reported to the appropriate authorities for further action. <br /> SECRETARY <br /> Sheana Funkhouser <br /> TREASURER <br /> Bradley Fox Board President <br /> Jesse Bassnight,Jr. Executive Director <br /> Michael Hill <br /> Suzanne Kalbas <br /> Joel Levy Sworn to and subscribed before me on the day of the date of said certification. <br /> Nancy Jones <br /> Cindy Skocik ..._ <br /> Mildred Witt — :1'P-0,D '-"C"–:::):1-, KESHA PATEL <br /> Notary Public <br /> Notary Signature and Seal <br /> EXECUTIVE Durham Co,North Carolina <br /> DIRECTOR My Commission Expires Aug.09,2020 <br /> Paul Klever <br /> My Commission Expires: 11.314 (L 2c 2 C) <br /> paul@charleshouse.org <br /> GS, 105-2431 defines:Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more <br /> alter the notice of final assessment was mailed to the taxpayer.The term does not include a tax debt, <br /> however,if the taxpayer entered into an installment agreement for the tax debt under G,S, 105-237 within <br /> 90 days after the notice of final assessment was mailed and has not failed to make any payments due <br /> under the installment agreement. <br /> 7 511 :Sunrise Road, Chapel 1)111, NC 27514 (919) 967-7570 <br />