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• Contract #68-2004 <br />Personalized Patient Home Assistance, Inc. <br />ATTACHII~NT E <br />OVERDUE TAXES <br />Orange County Department of Social Services and Orange County Department on Aging <br />~_, f ,~2 , 2008 <br />To: Orange County Department of Social Services and Orange County Department on <br />Aging <br />Certification: <br />I certify that Personalized Patient Home Assistance, Inc. does not have any overdue tax <br />debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I further <br />understand that any person who makes a false statement in violation of N.C.G.5. 143- <br />6.2(b2) is guilty of a criminal offense punishable as provided by N.C.G.S. 143-34(b). <br />Sworn Statement: <br />~VO T'~rYs ~ eing duly sworn, say that I am the ~~t1~'~'~r~t' ~-~"~ ~ <br />of Personalized Patient ome Assistance, Inc. of Chapel Hill in the State of North <br />Carolina; and that the foregoing certification is true, accurate and complete to the best of <br />my knowledge and was made- and subscribed by me. I also acknowledge and understand <br />that any misuse of State funds will be reported to the appropriate authorities for further <br />action. <br />Director <br />Sworn to and subscribed before me on the day of the date of said certification. <br />~. <br />(Notary Signa a and Seal) <br />• <br />My Commission Expires: ~~ /1 <br />Overdue Taxes - (06/04) Page 1 of 1 <br />