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6-6-22 BOC Regular Meeting
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6-6-22 BOC Regular Meeting
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Last modified
7/22/2022 10:48:06 AM
Creation date
7/22/2022 10:46:13 AM
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Template:
Admin-Clerk
Document Type
Contract
Committee
Board of Commissioners
Date
6/6/2022
Book No
34
Page No
179
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Forsyth Office <br /> 2554 Lewisville Clemmons Rd.,Ste 310 <br /> Clemmons,NC 27012 <br /> (336)714-9790 <br /> (1\lnipowering Lives Wake Office <br /> I 1 10 Navaho Drive,Ste 304 <br /> Raleigh,NC 27609 <br /> Guardianship Services, LLC (336)799-2223 <br /> 04/27/2022 <br /> To: County Department of Social Services/Human Services <br /> Certification: <br /> I certify that Empowering Lives Guardianship Services does not have any overdue tax debts, as defined <br /> by N.C.G.S. 105-243.1, at the federal, State, or local level. I further understand that any person who <br /> makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as <br /> provided by N.C.G.S.) 143C-10-1 b. <br /> Sworn Statement: <br /> Stacey Skradski, Manager/Owner being duly sworn, say that I am the Owner/Manager of Empowering <br /> Lives Guardianship Services of Clemmons in the State of North Carolina; and that the foregoing <br /> certification is true, accurate and complete to the best of our knowledge and was made and subscribed by <br /> us. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate <br /> authorities for further act n. <br /> r <br /> Owner Tanager <br /> Sworn to and subscribed before me on the day of the date of said certification. <br /> \\\ttOriN //// <br /> 'A •,�y)•,►t U9 '�% My Commission Expires: ft' - `1/-)('-1_ <br /> (Notary Signature"er 'Seal) <br /> _ publ;c <br /> Nota <br /> Forsryyth <br /> County <br /> 9C <br /> C 'SS. <br /> 'rrrrunnrrr�t� <br />
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