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DocuSign Envelope ID:87213ABF-3732-4E88-B475-AD615EF503C2 <br /> Exhibit E <br /> Naw Paw Paw Hser <br /> 2088 Softwinds Drive <br /> Graham,NC 27253 <br /> To: Grange 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. 105-243.1,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 /> I, 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 /> 'A. <br /> Signature <br /> Sworn to and subscribed before me on the day of U' , 201 <br /> pti►�rrrr�inr�rr��ryi <br /> tT '► <br /> •.� My Commission Expires: <br /> (Notary Signatu and al) <br /> r AUB L1G <br />