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DocuSign Envelope ID: 3E4B4B91- 8AA8 -41 OB- 8584- 11AAECCBC787 <br />ATTACHMENT E <br />OVERDUE TAXES <br />Orange County Department of Social Services <br />Instructions: Grantee /Provider should complete this certification for all funds received. Entity <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 />Medisolutions Inc. <br />0612912018 <br />To: Orange County Department of Social Services <br />Certification: <br />We certify that Med isol utions, Inc. does not have any overdue tax debts, as defined by N.C.G.S. <br />1 05- 243.1', at the federal, State, or ioc tl level. We further understand that any person who makes <br />a false statement in violation ofN.C.GI�S. 1430- 6 -23(c) is guilty of a criminal offense punishable <br />as provided by N.C.G.S. 1430- 10 -1(b). <br />Sworn Statement: <br />I <br />Oswald Nwogbo and ,lohn Okafor being duly sworn, say that we are the Board Chair and Chief <br />Operating Officer, respectively, of MOS011.16011s, Inc. of Burlington in the State of North <br />Carolina; and that the foregoing certification is true, accurate and complete to the hest of our <br />knowledge and as made and subscribed by us. We also acknowledge and understand that any <br />misuse of State/funds will I be re�orll:A to the appropriate authorities for further action. <br />Chief Operating Officer Cj <br />+`', %q'j„111'1F?Gwprn to and subscribed before me on the day of the date of said certification. <br />p o+ <br />1z 11 07A� }- `" <br />� <br />~ "r r My Commission Expires; - -6 2.01 Cr <br />s n'• AUBLrN064 Signature and Seal) <br />A�'/11111I11 i1N M1 +t ►" <br />I <br />' G.S, 105 -243.1 defines: Overdue lax debt. — A{ y part of a tax deist that remains unpaid 90 days or more after the <br />notice of final assessment was mailed to the taxpayer. The term aloes not include a tax debt, however, if the taxpayer <br />catered into an installliient ab cement for the tax debt under G.5. 105 -237 within 90 days after the notice of final <br />assessment was mailed and has not failed to mane any payments due under the installment agreement." <br />Overdue Taxes — (07108) Page i of I <br />