Orange County NC Website
Browse       Search
DocuSign Envelope ID: FBF0391 D-70C4-4BC1-A063-A23742F80EC1 <br /> Contract#68-2014 1 <br /> Senior Care of Orange County,Inc. <br /> ATTACHMENT E 1 <br /> OVERDUE TAXES <br /> Orange County Department of Social Services <br /> 1 <br /> Instructions: Grantee/Provider should complete this certification for all funds received. Entity <br /> II <br /> should enter appropriate data in the yellow highlighted areas. The completed and signed form <br /> must be provided to the County Department of Social Services. <br /> Florence Gray Soltys Adult Day Health Program <br /> b <br /> Operated by: Senior Care of Orange County,Inc. <br /> 105 Meadowland Drive li <br /> Hillsborough,North Carolina 27278 <br /> 1 <br /> 07/05/2017 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> l <br /> We certify that the Senior Care of Orange:Caunty 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 1 <br /> any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a l <br /> criminal offense punishable as provided by N.C.G.S. 143C-10-1(b). <br /> Sworn Statement: <br /> Nancy Esperson and David Wilkerson being duly sworn, say that we are the Board Vice President <br /> and Treasurer, respectively, of Senior Care of Orange County; Inc of Hillsborough in the State of 1 <br /> North Carolina; and that the foregoing certification is true, accurate and complete to the best of <br /> our knowledge and was made and subscribed by us. We also acknowledge and understand that <br /> any misuse of State funds will be reported to the appropriate authorities for furt o�rnehiot7,, <br /> ``,��,a∎"ye.A N N&-- ,,„ <br /> B•idVi - P side t ;° x10rq,Q % <br /> � 4rer - <br /> �r A _ <br /> �� °BLit G:' <br /> Sworn to and subscribed before me on the day of the date of said cettificatit s y?`� <br /> , c CO U N�,.,,,, <br /> ,,,,i,w u uu,,, 1 <br /> ,..,4l am— My Commission Expires: r a`( 1,D- ) t b <br /> t otary ign�nd Seal <br /> n <br /> �1 , t @ i Zseo-hv G.V1v1i ov-tk C-o.u1A-ki 1 <br /> i G.S. 105-243.1 defines:Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after the <br /> notice of final assessment was mailed to the taxpayer.The term does not include a tax debt,however,if the taxpayer <br /> entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final <br /> assessment was mailed and has not failed to make any payments due under the installment agreement." <br /> Overdue Taxes—(07/08) Page 1 of 1 <br />