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<br />.'l(]cP~~ <br /> <br />Cr~lIlillg S~llIlioH~ : <br />clmuSiuglill($. , <br />Easter Seals vcr North Carolina <br /> <br />......................Uy...U.Li ..........iv.... <br /> <br />Raleigh, NC 27607 <br />919.783.8898 <br />800.662.7119 <br />919.782.5486 fax <br /> <br />www.nc.eastersea1sucp.com <br /> <br />ATTACHMENT E - OVERDUE TAXES <br /> <br />Instructions: Grantee should complete this certification for all funds received. Entity <br />should enter appropriate data in the yellow highlighted areas. The completed and signed <br />form must be provided to the County Department of Social Services. <br /> <br />Date of Certification: July 11, 2006 <br /> <br />To: County Departf1'lent of Social Services <br /> <br />Certification: <br /> <br />We certify that Easter Sllals UCP North Carolina, Inc. does not have any overdue tax debts, as <br />defined by N.C.G.S. 10$-243.1, at the federal, State, or local level. We further understand that <br />any person who makes ~ false statement in violation of N.C.G.S. 143-6.2(b2) is guilty of a <br />criminal offense punish~ble as provided by N.C.G.S. 143-34(b). <br /> <br />Sworn Statement: <br /> <br />Lorraine Thielmann and Connie L. Cochran being duly sworn, say that we are the Board Chair <br />and President/CEO, respectively, of Easter Seals UCP North Carolina, Inc. of Raleigh in the State <br />of North Carolina; and that the foregoing certification is true, accurate and complete to the best of <br />our knowledge and wasimade and subscribed by us. We also acknowledge and understand that <br />any misuse of tate fun~s will be reported to tQe appropriate authorities for further action. <br /> <br />1/-' [.. C;) <br /> <br />"-. <br /> <br /> <br />Sworn to and subscribe~ before me on the day of the date of said certification. <br /> <br /> <br />My Commission Expires: / / - D/ - O~ <br /> <br />F-/5 <br />