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Contract #68-2012 <br />Southern Home Care Services, Inc. <br />ATTACffi1~NT E <br />__ _. _ _,__ _-- -._- - --- - - _ _____-. _ _ ------- -- _ __OI~RDUE_TAXES._ __ . _ __ _ <br />Orange County Department of Social Services and Orange County Department on Aging <br />~~~_~ ~, 2008 <br />To: Orange County Department of Social Services and Orange County Department on <br />Aging <br />Certification: <br />I certify that Southern Home Care Services, Inc., DBA ResCaze HomeCaze does not have <br />any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local <br />Level. I further understand that any person who makes a false statement in violation of <br />N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable as provided by N.C.G.S. <br />143-34(b). <br />Sworn Statem t: <br />1 <br />eing duly sworn, say that I am the . ` of <br />Southern Home Care Services, Inc., DBA ResCaze HomeCaze of Chapel Hill in the State <br />of North Carolina; and that the foregoing certification is true, accurate and complete to <br />the best of my knowledge and was made and subscribed by me. I also acknowledge and <br />understand that any misuse of State funds will be reported to the appropriate authorities <br />for ction. <br />Director _____ <br />Sworn to and subscribed before me on the day of the date of said certification. <br />(Notary Si nature and Seal) <br />My Commission Expires: v (~, ~ 2c~p <br /> <br />Overdue Taxes - (06/04) Page 1 of 1 <br />