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DocuSign Envelope ID: A07C4620 -D9F0- 4228- 9B2F- lD499E5F8796 <br />ATTACHMENT E <br />NO OVERDUE TAXES <br />TO: ORANGE COUNTY DSS AND ORANGE COUNTY DEPARTMENT OF AGING <br />FROM: DOROTHEA FARRINGTON <br />DATE: JUNE 50 , 2018 <br />Certification: <br />PERSONALIZED PATIENT HOME ASSISTANCE <br />WE CERTIFY THAT PERSONALIZED PATIENT HOME ASSISTANCE DOES NOT HAVE ANY <br />OVERDUE TAX DEBTS AS DEFINED BY N.C.G.S. 105 -243.1 AT THE STATE, FEDERAL OR <br />LOCAL LEVEL. WE FURTHER UNDERSTAND THAT ANY PERSON WHO MAKES A FALSE <br />STATEMENT IN VIOLATION OF N.GC.G.S. IS GUILTY OF A CRIMINAL OFFENSE <br />PUNISHABLE PYN.C.G.S. 143C- 10 -1(b). <br />Sworn Statement: <br />1, DOROTHEA FARRINGTON BEING DULY SWORN, STATE THAT I AM THE OWNER. OFD` <br />PERSONALIZED PATIENT HOME ASSISTANCE IN THE STATE OF NC AND THAT THE <br />FOREGOING CERTIFICATION IS TRUE, 1 UNDERSTAND THAI' ANY MISUSE OF STATE <br />FUNDS WILL BE REPORTED TO THE APPROPRIATE AUTHORITIES FOR FURTHER ACTION. <br />This the L309 day of :tune 2018. <br />C9'Lts�t�cn -' �-J <br />Dorothea FarriDgtOn, Owner <br />Sworn to and subscribed before me on the day of the data of said certification. <br />(Notary Signature and Seal) <br />DAISETTE STROUD <br />NOTARY PUBLIC <br />DURHAM COUNTY <br />STATE OF N6RTH CAROLINA <br />My Commission Expires: 1e ' 7/'5l,6 ''4` <br />