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DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C <br />To: State Agency Head and Chief Fiscal Officer <br />Certification: <br />We certify that the Inter - Faith Council for Social Service does not have any overdue tax debts, as <br />defined by N.C.G.S.1q,_243.1, 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 <br />offense punishable as provided by N.C,G.S.) 1430- 10-1b. <br />Sworn Statement, <br />Keith Taylor and Jackie Jenks being duly sworn, say that we are the Board Chair and Executive <br />Director, respectively, of Inter -Faith Council for Social Service o£ Carrboro in the State of North <br />Carolina; and that the foregoing certification is true, accurate and complete to the best of our <br />knowledge and was made and subscribed by us. We also acknowledge and understand that any <br />misuse of S ate funds w' be reported to the appropriate authorities for further action, <br />Board Chair <br />Executive Director <br />Sworn to and subscribed before me on the day of the date of said certification, <br />My Commission Expires: S, tY 2 7, z,-z.-L_ <br />Notary Signature and Seal) "' pmA$n�:� <br />TOMAS MATERIN <br />Notary Public <br />Wake Co., North Carolina <br />My Commissions Expires July 27, 2o22 <br />710 W. Main Street • Carrboro, NC 27510 -Phone 914 -929 -6380 -fax 919 -929 -3353 • www.lftweb.org <br />F <br />