2019-702-E DSS - Personalized Patient Home Assistance Inc in home aide services

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DocuSign Envelope ID:412EAE5F-3824-43FA-AC95-54AOC4DF83A2 ATTACHWNT E OVERDUE TAXES orange County Departiaient of Social Services PERSONALIMD PATIENT IE OMM ASSISTANCE 109 Concord Drive Chapel Hail,N.C.27516 September 12,2019 To: Orange County Department of Social Services Certification; We certify that Personalized Patient FI❑me Assistance does not have any overdue tax debts,as defined byIN.C.G.S. 105-243.11,at the federal,State,or local Icyel. We further understand that any per-son who makes a false statement in violation of N.C.G.S. 143C-6-23(c)is guilty of a criminal offense pui ishable as provided by N.C.G.S. 143C-1 0-1(b). Sworn Statement: Dorothea M.Farrington and Ross L,Farrington being duly sworn,say that we are the Director and Accounts Payable,respectively,of Personalized Patient Home Assistance 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 f mds will be reported to the appropriate authorities for further acti Director Accounts Payable S to and subscrib before m on the day of the date of said certification.My Conunission Expires_ �yy�� U 8 9,9, otary Signature an eal) 17. ON MARIE HOWARD SHANNON MARIE HOWARD Notary ?tabfir Notary Public North Carol- 3 North Carolina Orange Courtity Orange County G_S. 105-243.1 defincs:Overdue mx debt.—Any part of a tax debt that remains unpaid 90 days or more aftex the notice of final assessment was Tnailed to the taxpayer.Tbo term does not include a tax debt however,if the taxpayer entered into qn installment agreement for the tax debt under 0.5. 105•237 within 90 days after the notice of final assessment was mailed And has not failed to make any payments duo under the installment agreement." Overdue Taxes—(07108) Page 1 of 1 L�ELB 3Jdd i-UVVHWQ L956ZCEb0b 9I:91 6107,/ZZ16la