2017-428-E DSS - KAH Care, L.L.C dba Right at Home for in-home aides services

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DocuSign Envelope ID:695BA350-46C5-40DD-8F45-F768C9663EB4 ri 1 flight Hc nil e 4905 Pine Cone Drive, SUITE 2 I P 919.237.2333 I www.randch.com i In Homa Care 6 Aasletareeo DURHAM, NC 27707 I F 919.237.2152 I info @randch.com ATTACHMENT E OVERDUE TAXES i Orange County Department of Social Services Contract#68-2017 KAH Care, L.L.C.dba Right at Home Date: June 30,2017 To: Orange County Department of Social Services Certification: I certify that the KAH Care, LLC does not have any overdue tax debts,as defined by N.C.G.S. 105-243.11,at the federal, State,or local level. I further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S. 143C-10-1(b). Sworn Statement: Kenneth Helmuth being duly sworn says that he is the Board Chair of KAH Care,LLC of Durham in the State of North Carolina;and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by him. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Y 1 hair Sworn to and subscribed before me on the day of the date of said certification. Ducham County ... _;,air, I.Yt;tnt.:,0A... L.: ''''-r—7 7''----) \ -: V,. My Commission Expires:CS-rap/X.22_ �V ( got€try ,i :tture t detti) .. , • I G.S. 105-243.1 defines:Overdue lax debt.--Any part of a tax debt that remains unpaid 90 days or more after the notice of final • assessment was mailed to the taxpayer.The term does not include a tax debt,however, if the taxpayer entered into an installment agreement for the tax debt under G.S. (05-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement."