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27 <br /> C. Certification of No Overdue Tax Debts <br /> Date of Certification MM/DD/YYYY <br /> Certification: <br /> We certify that [ORGANIZATION NAME] 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 makes a false <br /> statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by <br /> N.C.G.S.) 143C-10-1b. <br /> Sworn Statement: <br /> [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are the <br /> Board Chair and [Title of the Second Authorizing Official], respectively, of[insert name of organization] of <br /> [City] in the State of[Name of State]; and that the foregoing certification is true, accurate and complete <br /> to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand <br /> that any misuse of State funds will be reported to the appropriate authorities for further action. <br /> Board Chair Signature <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: <br /> (Notary Signature and Seal) <br /> 1 G.S. 105-243.1 defines: Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more <br /> after the notice of final assessment was mailed to the taxpayer.The term does not include a tax debt, <br /> however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 <br /> within 90 days after the notice of final assessment was mailed and has not failed to make any payments <br /> due under the installment agreement." <br /> 3 <br />