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DocuSign Envelope ID: 1D49373B-59ED-43FD-853D-3535501F4D06 <br /> ATTACEDUNT E <br /> OVERDUE TAXES <br /> Orange County Department of Social Services <br /> Instructions: Grantee/Provider should complete this certification for all funds received.Entity <br /> should enter appropriate data in the yellow highlighted areas. The completed and sighed form <br /> must be provided to the County Department of Social Services. <br /> Beautiful Remissions <br /> September 13,2419 <br /> To: Orange County Department of Social Services <br /> Certification: <br /> We certify that Beautiful Remissions does not have any overdue tax debts,as defined by <br /> N.C.G.S. 105-243.1 t,at the federal,State,or local level. We further understand that any person <br /> who makes a false statement in violation ofN.C.G.S. 143C-5-23(c)is guilty of a criminal offense <br /> punishable as provided byN.C.G.S. 143C-10-1(b). <br /> Sworn Statement: <br /> Danielle Mcneil and Danielle Mcneil being duty sworn, say that we are the Board Chair and.Soul <br /> Owner,respectively,of Beautiful Remissions of Durham in the State of North Carolina;and that <br /> the foregoing certification is true,accurate and complete to the best of our knowledge and was <br /> made and subscribed by us. We also acknowledge and understand that any misuse of State funds <br /> will be reported to the appropriate authorities for further action. <br /> Danielle Mcneil <br /> Board Chair <br /> Soul Owner <br /> Title of Second Authorizing Official <br /> Sworn to and subscribed before me on the day of the date of said certification. <br /> My Commission Expires:-7— 1-7- .2 o .2 <br /> Notary Signature and S } MILLICENT STflrl E <br /> NOTARY PUBLIC <br /> DURHAM COUNTY,NC <br /> MY Commission Expims 7-17-2021 <br /> G.S.4 05-243.1 defines.Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after the <br /> notice of Final assessment was mailed to the taxpayer.The term does not include a tax debt,however,if the taxpayer <br /> entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final <br /> assessment was mailed and has not failed to make any payments due under the installment agreement." <br /> Overdue Taxes—(07/08) Page 1 of 1 <br />