Orange County NC Website
Browse       Search
DocuSign Envelope ID:34046D39-94E5-43C6-BCAA-BF969263E26C <br /> Exhibit E <br /> Silvia Lissette Saca <br /> 103 N. Crabtree Knoll <br /> Chapel Hill,NC 27514 <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 Silvia Lissette Saca; and that the foregoing certification <br /> is true, accurate and complete to the best of my knowledge and was made and subscribed <br /> by me. I also acknowledge and understand that any misuse of State funds will be <br /> reported to the appropriate authorities for further action. <br /> Sig -at "� <br /> Sworn to and subscribed before me on the wry <br /> �'/' day of , 201 r/. <br /> 09a/fre. <br /> Xt .i,/,,a My Commission Expires: 4%09.-9.- <br /> (N• a Signature and Seal) <br /> �� StA fT►t�R,,,�/% <br /> Os <br /> 1,414,r, Y <br /> pVeLiC <br /> C, <br /> y'/''/'3 C11O11`jl T41„```•- <br />