2018-584-E DSS - FlairCare-Homewatch Caregivers in home aide services

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DocuSign Envelope ID: D6A10EDE-9B06-43F7-AB6A-BOCF29ADEBA4 Homewatch C dlk 1"A9311 L� Lot our family care for yours." August 13, 2018 To: Orange County Department of Social Services Certification: We certify that FlairCare, Inc., dba Hornewatch CareGivers of the Triangle,does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1{, at the federal,State,or local level. We Further understand that any person who makes a false statement in violation of N.C.G.S. 1430-6- 23(c)is guilty of criminal offense punishable as provided by N.C.G.S. 1430-10-1(b), Sworn Statement, Anzor Gachechiladze and Kimberly Flair being,duly sworn, say that we are the Board Chair and Secretary/Treasurer of the Board respectively, of F1airCare, Inc., dba Hornewatch CareGivers of the Triangle of Chapel Hill in the State of North Carolina-,and that the foregoing,certification is true,accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will he reported to the appropriate authorities for r action. Board h Secretatry/Treagurer of the Board Sworn to and subscribed'before me on the day of the date of said certification. EN • eR0 d3AR1! C I- ission Expires: (Notary Signature and Seal) PU13LIC y�+ ► c�U l G.S. 105-243.1 dcriincv.Overdue tax debt.—Any part of a tax debt dial remains unpaid 90 days or more after die notice of final assessment%vas mailed to the Wxpayer.The terra does not include a tax debt,hmYever,if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days aflcr the notice of final assessment%vas mailed and has not railed to make any payments due under the installment agreement." 101 Cosgrove Ave,Ste 120 Chapel Hill NC 27514 1210 SE Maynard Rd,Ste 202 Cary NC 27511 919.960.6038 919.461.3741 hweg.com