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d 5 J uP jl - .#&& COMMUNITY ACTION AGENCY, INC. 1300W. Bank St. • Salisbury, NC 28144 • Phone: 704- 633 -6633 • Fax: 704- 633 -7514 William "Pete" Kennedy, Board Chairman S SO Y. Tammy Corpening, Treasurer Donna W. Cook, Vice Chair CP //�� qy Carlos Watsan, Parliamentarian Suzette Davis, Secretary J7C✓frt0' 11 Stanley Wilson, Executive Director C hang ing People's LN Livn Al71aN November 18, 2014 To, State Agency Head and Chief Fiscal Officer Certification: We certify that the Salisbury Rowan Community Action Agency does not have any overdue tax debts, as defined by N.C.G.S. 165- 243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C- 6 -23(c) is guilty of a criminal offense punishable as provided by N.C.G.S. 143C- 10-1b. Sworn Statement: William Kennedy and Stan Wilson being duly sworn, say that we are the Board Chair and Executive Director, respectively, of Salisbury Rowan Community Action Agency of Salisbury 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 fu s will be ported to the appropriate authorities for further action. B fIrd Chair Executive Sworn to and subscribed before me on the day of the date of said certification, X�1 C`k)l tti ;` � SHARON SHALL My Commission Expires: 11 �� + (Notary Signature and Seal) NOTARY PUBLIC ROWAN COUNTY, K.C, MY COMMISSION EXPIRES:I L- � If there are any questions, please contact the state agency that provided your grant. If needed, you may contact the North Carolina Office of State Budget and Management: NCGrants @osbtrt.nc.gov -(91 9)807 -4795 ' 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. 905 -237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement," Page I of 1 MS&NCD Form 0008 Eff. July 1, 2005 Revised July 18, 2006, 7107, 8/09, 9111 An Equal Opportunity Employer www.srcaa.com F - 13 Attachment number 1 Page 280