Orange County NC Website
DocuSign Envelope ID: 53EDA064- 8713- 4EAA- 828B- 4C2296C1101`6 <br />Attachment E <br />Naw Paw Paw Hser <br />2488 Softwinds Drive <br />Graham, NC 27253 <br />To: Orange County Department of Social Services <br />Certification: <br />I certify that I do not have any overdue tax debts, as defined by N.C.G.S. 145 - 243.1, at <br />the federal, State, or local level. I further understand that any person who makes a false <br />statement in violation of N.C.G.S. 143- 6.2(b2) is guilty of a criminal offense punishable <br />as provided by N.C.G.S. 143- 34(b). <br />Sworn Statement: <br />1, being duly sworn, say that I am Naw Paw Paw Hser; and that the foregoing <br />certification is true, accurate and complete to the best of my knowledge and was made <br />and subscribed by me. I also acknowledge and understand that any misuse of State funds <br />will be reported to the appropriate authorities for further action. <br />4 <br />Signature <br />r <br />Sworn to and subscribed before me on the day of Q �" , 241 i <br />"."04 <br />(Notary <br />PAM <br />and Se j) <br />G$L IC <br />L� <br />My Commission Expires: 5 ?-02- 2� <br />