Orange County NC Website
Browse       Search
State Grant Certification -No Overdue Tax Debts <br />Instructions: Grantee/Contractor should complete this certification for all state funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form should be provided to the state agency funding the grant to be attached to the contract for the grant funds. A copy of this form, along with the completed contract, should be kept by the funding agency and available for review by the Office of State Budget and Management. <br />Note: ff you have a contract that extends more than one state fiscal year, you will need to obtain an updated certification for <br />each year of the contract. <br />First-Watch Homecare, LLC <br />04/24/2024 <br />To: Nancy Coston, Director, Orange County Department of Social Services <br />Certification: <br />We certify that the First-Watch Homecare, LLC does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person whomakes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable <br />as provided by N.C.G.S.) 143C101b. <br />Sworn Statement: <br />Geanda Tilley and Nakita Wilson being duly sworn, say that we are the Board Chair and Administrative Assistant, respectively, of First-Watch Homecare, LLC of Durham 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 funds will be reported to the appropriate authorities for further action. <br />Geanda Tilley Board Chair Nakita Wilson Administrative Assistant <br />Sworn to and subscribed before me on the day of the date of said certification. <br />FELICIA CULBRETH NOTARY PUBLIC Wake County North Carolina <br />� • (\ ,, " � � (Noary Signature and Seal) <br />My Commission Expires 5/24/2026 <br />My Commission Expires: 5-.;ll/• 2<'.J2(.e, <br />If there are any questions, please contact the state agency that provided your grant. If needed, you may contact the North <br />Carolina Office of State Budget and Management: <br />NCGrants@osbm.nc.gov-(919)807-4 795 <br />' G.S. 105-243.1 defines: Overdue tax debt. -Any part of a tax debt that remains unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement." <br />MS&NCD Form 0008 <br />Eff. July 1, 2005 <br />Revised July 18, 2006, 7/07, 8/09, 9/11 <br />Page 1 of 1 <br />DocuSign Envelope ID: 011CA84E-8FCF-40B9-9D8F-7305C5E1FD4D