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DocuSign Envelope ID:84924C7D-EDF6-41D3-81F5-3503EDF23805 adze 9199330914 PAGE. 5/ 5 <br /> Home atch <br /> Carverse <br /> Let our family care for yours.T"4 <br /> Date of Certification: October 27, 2017 <br /> To: Orange County Department of Social Services <br /> Subject: Attachment B "Overdue Taxes" <br /> Certification: <br /> We certify that FlairCare,Inc., dba Homewatch CareGivers of the Triangle does not have <br /> any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local <br /> level. We further understand that any person who makes a false statement in violation of <br /> N.C.G.S. 143C-6-23(c) is guilty ot`a criminal offense punishable by N.C.G.S. 143C-10- <br /> 1(b). <br /> Sworn Statement: <br /> Anzor Gachechiladze and Kimberly Flair being duly sworn, say that we are the Board <br /> Chair and Secretary/Treasurer, respectively, of FlairCare, Inc,, dba Homewatch <br /> CareGivers of the Triangle of Chapel Hill in the State of North Carolina; and that the <br /> foregoing certification is true, accurate, and complete to the best of our knowledge and <br /> was made and subscribed by us. We also acknowledge and understand that any misuse of <br /> State funds will be reported to the appropriate authorities for further action. <br /> 4-6.4ra 96'%--,c. <br /> is <br /> Anzor Gache hiladze,Board Chair Kimberly Flair, ecretary/Treasurer <br /> Sworn to and subscribed befor A ' YIHi440y of the date of said certification. <br /> jp. commission expires:in cL ,.7 <br /> otary Signature and Sear <br /> e6„g AN100 <br /> Ave <br /> 101 Cosgrove ,S e 120 Chapel dill NC 27514 <br /> 1210 SE Maynard Rd,Ste 202 Cary NC 27511 <br /> 919.960.6038 919.461.3741 hwcg,com <br />