Orange County NC Website
DocuSign Envelope ID:86C86165-F915-4C58-8C57-2284F5D9E950 <br /> Exhibit E <br /> Daniel Qiao <br /> 1323 Northcreek Dr <br /> Durham,NC 27707 <br /> To: Orange 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 ofN.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 Daniel Qiao; and that the foregoing certification is true, <br /> accurate and complete to the best of my knowledge and was made and subscribed by me. <br /> I also acknowledge and understand that any misuse of State funds will be reported to the <br /> appropriate authorities for further action. <br /> Signature <br /> Sworn to and subscribed befomow' 0 , 1 day of r� , 2020. <br /> r p'�A►4 ? <br /> �� Iz <br /> My Commission Expires: � <br /> otary Sig-n-att and Sea UB1. Cif <br /> Sy�;4z4 C0v0.'A00 V <br />