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DocuSign Envelope ID:29F69F49-AF01-438A-86A0-C2EF1EC6D661 <br /> Exhibit E <br /> Melissa Childers <br /> 112 West Hill Ave, N <br /> Hillsborough,NC 27278 <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 Melissa Childers; and that the foregoing certification is <br /> true, accurate and complete to the best of my knowledge and was made and subscribed by <br /> me. I also acknowledge and understand that any misuse of State funds will be reported to <br /> the appropriate authorities for further action. <br /> l/L <br /> Signature <br /> Sworn to and subscribed before me on the v- .2 clay of U ,2011. <br /> `�rplrf llf l5!llJ <br /> M Commission Expires: <br /> I 1 <br /> Y p <br /> (Notary Si tore an eeal),_- w= <br /> r F+ 6e-;I y i_, 7► <br /> v <br />