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DocuSign Envelope ID:F779B82D-01C3-4826-8606-CA75617BC6AA <br /> Attachment E <br /> Naw Paw Paw Hser(Ken Ket) <br /> 749 Sehom Circle <br /> Efland,NC 27243 <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 Paw Hser; and that the foregoing <br /> certification is true, accurate and complete to the best of my knowledge and was made <br /> and subscribed by me. I also acknowledge and understand that any misuse of State funds <br /> will be reported to the appropriate authorities for further action. <br /> /4 <br /> Signature <br /> Sworn to and subscribed before me on the a day of ,AL: , 201 l . <br /> f <br /> I // My Commission Expires: /—a9—/e <br /> (No/0, Signature and Seal) <br /> 011 16,811 <br /> As <br /> r NOTARY I <br /> i <br /> PUBLIC 01 <br /> gait r <br /> vim`'` <br /> ,''��''''��I I I`,I 111",`\`�� <br />