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AG 2007 06 18
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AG 2007 06 18
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Last modified
9/26/2007 2:40:23 PM
Creation date
11/27/2017 11:30:53 AM
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Meeting Minutes
Doc Type
Agenda
Meeting Minutes - Date
9/26/2007
Board
Board of Commissioners
Meeting Type
Regular
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Insreuclions: Grantee should complete this certification fir all state funds received. Entity should enter appropriate <br />data in the yellow highlighted areas. The completed and signed form should be provi<ed to the state <br />agcne}` funding the grant to be attached to the contract for the grant funds. A copy of this form, along <br />with the completed cmrtract, should be kept by the funding agency and mailable for review by the Office <br />of the State Auditor. If yoo have questions, contact: Angela Gum:, Office of fhc State Auditm•, 919-807- <br />7556. <br />ATTACHMENT E <br />CERTIFICATION OF NO OVERDUE TAX DEBTS <br />Entity's Letterhead <br />[Date of Certification (mmddyyyy)] <br />To: State Agency Heacl and Chief Fiscal Officer <br />Certification: <br />We certify that the [rnserl orgunizntion's name) does not have any overdue tax debts, as defined by N.C.G.S. 105- <br />243.1, at the federal, State, or local level. We further uoderstand that any person who makes a false statement in violation <br />of N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable as provided by N.C.G.S. 143-34(b). <br />Sworn Statement: <br />[Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are the Board Chair and <br />[Title of the Second Authorizing Offtcial], respectively, of [insert name of organization] of [City] in the State of [Name of <br />State]; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and <br />subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to the appropriate <br />authorities for further action. <br />Board Chair <br />[Title of Second Authorizing Official] <br />Sworn to and subscribed before me on the day of the date of said certification. <br />(Notary Signature and Seal) <br />My Camnission Expires: <br />If there are any questions, please contact the North Carolina Office of the State Auditor: <br />Angela Gunn @ (919) 807-7556 or <br />Harriet Abraham @ (919) 807-7673. <br />DHHS (Contract) (General) (03!07) ~ ~ I 12 <br />
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