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DocuSign Envelope ID:5330770B-8F93-4746-9A9E-98B8628F995F <br /> Rlgh! <br /> nit <br /> HOR1'1�' 4905 Pine Cane drive,SUITE 2 P 919.237,2333 www.randch.com <br /> DURHAM,NC 27707 f F 919.237.2152 kh@randch.corn <br /> r <br /> i <br /> ATTACHMENT>E <br /> ' OVERDUE TAXES <br /> Orange County Department of Social Services <br /> Contract# <br /> KAH Care,G.L.C. dba Right at Home <br /> Date: August 5,2019 <br /> 1 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that the KAH Care.LLC does not have any overdue tax debts,as defined by N.C.G.S. <br /> 105-243,1,at the federal,State,or local level. We further understand that any person who maces a <br /> false statement in violation ofN.C.G.S. 143C-5-23(c)is guilty of criminat offense punishabie as <br /> provided byN.C.G,S.) 143C-10-1b. <br /> Sworn Statement: <br /> Kenneth Helmuth being duly sworn says that he is the Board Chair and sole Managing Member of <br /> KAH Care, LLC of Durham in the State of North Carolina: and that the foregoing certification is <br /> true,accurate and complete to the best of our knowledge and was made and subscribed by us. We <br /> also acknowledge and understand that any misuse of State funds will be reported to the appropriate <br /> authorities for further action- <br /> f � <br /> Sworn to and subscribed before me on the day of the date of said certification. <br /> of - Seal) [ ] <br /> My Commission Expires: <br /> MICHAEL R PICORNELL ~ <br /> Notary Public,North Carolina <br /> Orange County <br /> My Co isslo�piss <br /> L2 ' <br /> f <br /> t <br />