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DocuSign Envelope ID: 1AA2F077-28D9-471D-964E-FC29B8D9OBCA <br /> pREmIER <br /> home &will) cure services,/1c. <br /> August 7,2017 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that the Premier Home Health Care Services,Inc. does not have any overdue tax debts, as <br /> defined by N.C.G.S. 105-243.11, at the federal, State, or local level. We further understand that any <br /> person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense <br /> punishable as provided by N.C.G.S. 143C-10-1(b), <br /> r <br /> G^L <br /> Sworn Statement: <br /> Artie Schwabe and Gregory Turchan being duly sworn, say that we are the Board Chair and Chief <br /> Operating Officer, respectively, of Premier Home Health Care Services,Inc. in the State of North <br /> Carolina and that the foregoing certification is true, accurate and complete to the best of our knowledge <br /> and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds <br /> will be reporte. •• The appropriat--autl bri 'es for further action. <br /> , --7. .,•-• , P <br /> } <br /> Board Chair <br /> . ' L r- „ <br /> Chief Operating Office '— <br /> Sworn to and subscribed before me on the day of the date of said certification. ry=.. <br /> :wsa, <br /> . , / V' ,. <br /> l <br /> (': - /''L Pei;4-' My Con►mission Expires: 6 __ j(i / ir(N Signarire and Seal) j otary �� <br /> ALICE 3. LOUSBERG <br /> • <br /> NOTARY PUBLIC STATE OF NEW YORK <br /> NO. 01L06043539 <br /> QUALIFIED IN DUTCHESS COUNTY ens <br /> COMMISSION EXPIRES JUNE 19,20 <br /> 4455l'imilton Avenue, 110th Fluor,Who Plains, New York 1U601 Phone 994-428-7722 Fax hi 4-428-2404 <br /> • <br /> • <br />