Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain: 1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed. 2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 To: Davidson County Department of Social Services I certify that Xxxxxx X. Xxxxx does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx X. Xxxxx being duly sworn, say that I am owner and manager of Xxxxxx X. Xxxxx, a professional association engaged in the practice of law in Wallburg in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification.
Appears in 1 contract
Samples: Legal Services Agreement
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. An electronic copy of the form may be accessed at xxxxx://xxx0.xxxxxx.xxx/dss/contracts/County%20Contract%20Forms.htm. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I We certify that Xxxxxx X. Xxxxx the [insert organization’s name] does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that I am owner we are the Board Chair and manager [Title of Xxxxxx X. Xxxxxthe Second Authorizing Official], a professional association engaged in the practice respectively, of law in Wallburg [insert name of organization] of [City] in the State of North Carolina [Name of State]; and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by meus. I We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution Board Chair [Title of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Second Authorizing Official] Sworn to and subscribed before me on the day of the date of said certification. (Official Seal) Notary Public My Commission expires , 20 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.”
(a) He or she is the duly authorized representative of the Contractor named below;
Appears in 1 contract
Samples: Foster Care Services Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 Clemmons, N.C. 27012 To: Davidson County Department of Social Services I certify that Xxxxxx X. Xxxxx Xxxxx& Xxxxxxxx, PLLC dba Clemmons Family Law PLLC does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx X. Xxxxx & Xxxxxxxx, PLLC dba Clemmons Family Law being duly sworn, say that I am owner and manager of Xxxxxx X. XxxxxXxxxx & Xxxxxxxx, a PLLC dba Clemmons Family Law. A professional association engaged in the practice of law in Wallburg Clemmons in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx & Xxxxxxxx, PLLC dba Clemmons Family Law PLLC Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” This Agreement is made effective the 26th day of September, 2022 by and between Davidson County Department of Social Services (“Covered Entity”) and Xxxxx & Xxxxxxxx, PLLC dba Xxxxxxxx Family Law (“Business Associate”) (collectively the “Parties”).
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I I, Lexa Eagle, certify that Xxxxxx X. Xxxxx does I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx I, Lexa Eagle, being duly sworn, say that I am owner and manager an independent contractor of Xxxxxx X. Xxxxx, a professional association engaged in the practice of law in Wallburg Davidson County DSS in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Lexa Eagle Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” nonprofit’s objective. Another option is to apply for a 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax-free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition of tax-exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and nonprofit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. How does a Private Non-Profit obtain Tax Exempt Status? EO Web Site [ xxx.xxx.xxx/xx] You may direct technical and procedural questions concerning charities and other nonprofit organizations, including questions about your tax-exempt status and tax liability, to the IRS Tax Exempt and Government Entities Customer Account Services at (000) 000-0000 (toll-free number). If you prefer to write, you may write at: Internal Revenue Service Exempt Organizations Determinations P.O. Xxx 0000 Xxxxxxxxxx, XX 00000 You may also contact the Taxpayer Advocate Service, an independent organization within the IRS that helps taxpayers resolve problems with the IRS and recommends changes that will prevent problems. A private nonprofit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax-exempt status is granted, the private nonprofit applies for State tax exempt status by completing Form CD-435 and submitting it to the N. C. Department of Revenue. • Article 2 of Chapter 64: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf • G.S. 133-32: xxxx://xxx.xxxx.xxxxx.xx.xx/gascripts/statutes/xxxxxxxxxxxxx.xx?statute=133-32 • Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009): xxxx://xxx.xxxxxxxxxxxxxxxx.xx.xxx/library/pdfs/Laws/EO24.pdf • G.S. 105-164.8(b): xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105- 164.8.pdf • G.S. 143-48.5: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 48.5.html • G.S. 143-59.1: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.1.pdf • G.S. 143-59.2: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.2.pdf • G.S. 143-133.3: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 133.3.html • G.S. 143B-139.6C: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143B/GS_143B- 139.6C.pdf
(1) Pursuant to G.S. 133-32 and Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009), the undersigned hereby certifies that the Contractor named below is in compliance with, and has not violated, the provisions of either said statute or Executive Order.
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires _ , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. An electronic copy of the form may be accessed at xxxxx://xxx0.xxxxxx.xxx/dss/contracts/County%20Contract%20Forms.htm. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I We certify that Xxxxxx X. Xxxxx the [insert organization’s name] does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that I am owner we are the Board Chair and manager [Title of Xxxxxx X. Xxxxxthe Second Authorizing Official], a professional association engaged in the practice respectively, of law in Wallburg [insert name of organization] of [City] in the State of North Carolina [Name of State]; and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by meus. I We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution Board Chair [Title of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Second Authorizing Official] Sworn to and subscribed before me on the day of the date of said certification. (Official Seal) Notary Public My Commission expires , 20 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.”
(a) He or she is the duly authorized representative of the Contractor named below;
Appears in 1 contract
Samples: Foster Care Services Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this _ day of , . (Official Seal) Notary Public My Commission expires , 20 To: Davidson County Department of Social Services I certify that Xxxxxx Xxxxxxx X. Xxxxx does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx Xxxxxxx X. Xxxxx Xxxxx, being duly sworn, say that I am owner and manager of Xxxxxx Xxxxxxx X. Xxxxx, a Attorney at Law. A professional association engaged in the practice of law in Wallburg in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx Xxxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” This Agreement is made effective the 1st day of July, 2024 by and between Davidson County Department of Social Services (“Covered Entity”) and Xxxxxxx X. Xxxxx (“Business Associate”) (collectively the “Parties”).
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official or Individual Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 To: Davidson County Department of Social Services I certify that Xxxxxx X. Xxxxx does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx X. Xxxxx being duly sworn, say that I am owner and manager of Xxxxxx X. Xxxxx, a professional association engaged in the practice of law in Wallburg in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . (Official Seal) Notary Public My Commission expires , 20 To: County Department of Social Services I certify that I, Xxxxxxx Xxxxx, do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, 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. I, Xxxxxxx Xxxxx, being duly sworn, say that I am an independent contractor of Lexington 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 me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxxx Xxxxx Date Sworn to and subscribed before me on the day of the date of said certification. (Official Seal) Notary Public My Commission expires , 20 _ 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” • Article 2 of Chapter 64: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf • G.S. 133-32: xxxx://xxx.xxxx.xxxxx.xx.xx/gascripts/statutes/xxxxxxxxxxxxx.xx?statute=133-32 • Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009): xxxx://xxx.xxxxxxxxxxxxxxxx.xx.xxx/library/pdfs/Laws/EO24.pdf • G.S. 105-164.8(b): xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105- 164.8.pdf • G.S. 143-48.5: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 48.5.html • G.S. 143-59.1: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.1.pdf • G.S. 143-59.2: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.2.pdf • G.S. 143-133.3: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 133.3.html • G.S. 143B-139.6C: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143B/GS_143B- 139.6C.pdf
(1) Pursuant to G.S. 133-32 and Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009), the undersigned hereby certifies that the Contractor named below is in compliance with, and has not violated, the provisions of either said statute or Executive Order.
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 _ To: Davidson County Department of Social Services I certify that Xxxxxxxx Xxxxxx X. Xxxxx Xxxxxx Attorney & Counselors at Law does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx X. Xxxxx being duly sworn, say that I am owner and manager of Xxxxxxxx Xxxxxx X. Xxxxx, a Xxxxxx Attorneys & Counselors at Law. A professional association engaged in the practice of law in Wallburg Lexington in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxxxx Xxxxxx X. Xxxxx Xxxxxx Attorneys & Counselors at Law Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” This Agreement is made effective the 1st of July, 2024 by and between Davidson County Department of Social Services (“Covered Entity”) and Xxxxxxxx Xxxxxx Xxxxxx Attorneys & Counselors at Law (“Business Associate”) (collectively the “Parties”).
Appears in 1 contract
Samples: Legal Services Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I I, Lexa Eagle, certify that Xxxxxx X. Xxxxx does I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx I, Lexa Eagle, being duly sworn, say that I am owner and manager an independent contractor of Xxxxxx X. Xxxxx, a professional association engaged in the practice of law in Wallburg Davidson County DSS in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Lexa Eagle Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” nonprofit’s objective. Another option is to apply for a 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax-free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition of tax-exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and nonprofit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. How does a Private Non Profit obtain Tax Exempt Status? EO Web Site [ xxx.xxx.xxx/xx] You may direct technical and procedural questions concerning charities and other nonprofit organizations, including questions about your tax-exempt status and tax liability, to the IRS Tax Exempt and Government Entities Customer Account Services at (000) 000-0000 (toll-free number). If you prefer to write, you may write at: Internal Revenue Service Exempt Organizations Determinations X.X. Xxx 0000 Xxxxxxxxxx, XX 00000 You may also contact the Taxpayer Advocate Service, an independent organization within the IRS that helps taxpayers resolve problems with the IRS and recommends changes that will prevent problems. A private nonprofit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax exempt status is granted, the private nonprofit applies for State tax exempt status by completing Form CD-435 and submitting it to the N. C. Department of Revenue. • Article 2 of Chapter 64: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf • G.S. 133-32: xxxx://xxx.xxxx.xxxxx.xx.xx/gascripts/statutes/xxxxxxxxxxxxx.xx?statute=133-32 • Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009): xxxx://xxx.xxxxxxxxxxxxxxxx.xx.xxx/library/pdfs/Laws/EO24.pdf • G.S. 105-164.8(b): xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105- 164.8.pdf • G.S. 143-48.5: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 48.5.html • G.S. 143-59.1: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.1.pdf • G.S. 143-59.2: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.2.pdf • G.S. 143-133.3: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 133.3.html • G.S. 143B-139.6C: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143B/GS_143B- 139.6C.pdf
(1) Pursuant to G.S. 133-32 and Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009), the undersigned hereby certifies that the Contractor named below is in compliance with, and has not violated, the provisions of either said statute or Executive Order.
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is _ of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I I, Xxxxx Xxxxx, certify that Xxxxxx X. Xxxxx does I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. I, Xxxxx Xxxxx, being duly sworn, say that I am owner and manager an independent contractor of Xxxxxx X. Xxxxx, a professional association engaged in the practice of law in Wallburg Davidson County DSS in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” nonprofit’s objective. Another option is to apply for a 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax-free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition of tax-exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and nonprofit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. How does a Private Non-Profit obtain Tax Exempt Status? EO Web Site [ xxx.xxx.xxx/xx] You may direct technical and procedural questions concerning charities and other nonprofit organizations, including questions about your tax-exempt status and tax liability, to the IRS Tax Exempt and Government Entities Customer Account Services at (000) 000-0000 (toll-free number). If you prefer to write, you may write at: Internal Revenue Service Exempt Organizations Determinations P.O. Xxx 0000 Xxxxxxxxxx, XX 00000 You may also contact the Taxpayer Advocate Service, an independent organization within the IRS that helps taxpayers resolve problems with the IRS and recommends changes that will prevent problems. A private nonprofit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax-exempt status is granted, the private nonprofit applies for State tax exempt status by completing Form CD-435 and submitting it to the N. C. Department of Revenue. • Article 2 of Chapter 64: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf • G.S. 133-32: xxxx://xxx.xxxx.xxxxx.xx.xx/gascripts/statutes/xxxxxxxxxxxxx.xx?statute=133-32 • Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009): xxxx://xxx.xxxxxxxxxxxxxxxx.xx.xxx/library/pdfs/Laws/EO24.pdf • G.S. 105-164.8(b): xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105- 164.8.pdf • G.S. 143-48.5: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 48.5.html • G.S. 143-59.1: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.1.pdf • G.S. 143-59.2: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.2.pdf • G.S. 143-133.3: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 133.3.html • G.S. 143B-139.6C: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143B/GS_143B- 139.6C.pdf
(1) Pursuant to G.S. 133-32 and Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009), the undersigned hereby certifies that the Contractor named below is in compliance with, and has not violated, the provisions of either said statute or Executive Order.
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. An electronic copy of the form may be accessed at xxxxx://xxx0.xxxxxx.xxx/dss/contracts/County%20Contract%20Forms.htm. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I We certify that Xxxxxx X. Xxxxx the [insert organization’s name] does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that I am owner we are the Board Chair and manager [Title of Xxxxxx X. Xxxxxthe Second Authorizing Official], a professional association engaged in the practice respectively, of law in Wallburg [insert name of organization] of [City] in the State of North Carolina [Name of State]; and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by meus. I We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution Board Chair [Title of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Second Authorizing Official] Sworn to and subscribed before me on the day of the date of said certification. (Official Seal) Notary Public My Commission expires , 20 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.”
(a) He or she is the duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the following certifications on behalf of the Contractor, as set out herein:
a. The Certification Regarding Nondiscrimination;
b. The Certification Regarding Drug-Free Workplace Requirements;
c. The Certification Regarding Environmental Tobacco Smoke;
d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions; and
e. The Certification Regarding Lobbying;
(c) He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the addresses at which the contract work will be performed;
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that _ personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 Clemmons, N.C. 27012 To: Davidson County Department of Social Services I certify that Xxxxxx X. Xxxxx Xxxxx& Xxxxxxxx, PLLC dba Xxxxxxxx Family Law PLLC does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx X. Xxxxx & Xxxxxxxx, PLLC dba Xxxxxxxx Family Law being duly sworn, say that I am owner and manager of Xxxxxx X. XxxxxXxxxx & Xxxxxxxx, a PLLC dba Xxxxxxxx Family Law. A professional association engaged in the practice of law in Wallburg Clemmons in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx & Xxxxxxxx, PLLC dba Clemmons Family Law PLLC Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” This Agreement is made effective the 1st day of July, 2024 by and between Davidson County Department of Social Services (“Covered Entity”) and Xxxxx & Xxxxxxxx, PLLC dba Xxxxxxxx Family Law (“Business Associate”) (collectively the “Parties”).
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 Clemmons, N.C. 27012 To: Davidson County Department of Social Services I certify that Xxxxxx X. Xxxxx Xxxxx& Xxxxxxxx, PLLC dba Xxxxxxxx Family Law PLLC does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx X. Xxxxx & Xxxxxxxx, PLLC dba Clemmons Family Law being duly sworn, say that I am owner and manager of Xxxxxx X. XxxxxXxxxx & Xxxxxxxx, a PLLC dba Xxxxxxxx Family Law. A professional association engaged in the practice of law in Wallburg Clemmons in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx & Xxxxxxxx, PLLC dba Xxxxxxxx Family Law PLLC Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” This Agreement is made effective the 1st day of January, 2021 by and between Davidson County Department of Social Services (“Covered Entity”) and Xxxxx & Xxxxxxxx, PLLC dba Clemmons Family Law (“Business Associate”) (collectively the “Parties”).
Appears in 1 contract
Samples: Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 To: Davidson County Department of Social Services I certify that Xxxxxx Xxxxxxx X. Xxxxx does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. Xxxxxx Xxxxxxx X. Xxxxx Xxxxx, being duly sworn, say that I am owner and manager of Xxxxxx Xxxxxxx X. Xxxxx, a Attorney at Law. A professional association engaged in the practice of law in Wallburg in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx Xxxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” This Agreement is made effective the 1st day of July, 2024 by and between Davidson County Department of Social Services (“Covered Entity”) and Xxxxxxx X. Xxxxx (“Business Associate”) (collectively the “Parties”).
Appears in 1 contract
Samples: Legal Services Agreement
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. An electronic copy of the form may be accessed at xxxxx://xxx0.xxxxxx.xxx/dss/contracts/County%20Contract%20Forms.htm. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I We certify that Xxxxxx X. Xxxxx the [insert organization’s name] does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx [Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that I am owner we are the Board Chair and manager [Title of Xxxxxx X. Xxxxxthe Second Authorizing Official], a professional association engaged in the practice respectively, of law in Wallburg [insert name of organization] of [City] in the State of North Carolina [Name of State]; and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by meus. I We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution Board Chair __ [Title of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Second Authorizing Official] Sworn to and subscribed before me on the day of the date of said certification. (Official Seal) Notary Public My Commission expires , 20 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.”
(a) He or she is the duly authorized representative of the Contractor named below;
Appears in 1 contract
Samples: Foster Care Services Contract
Record of Conflict. The minutes of the governing board and all committees with board delegated powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. . Approved by: Name of Organization Signature of Organization Official Date NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of I, , Notary Public for said County and State, certify that personally appeared before me this day and acknowledged that he/she is _ of [enter name of entity] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the day of , . Sworn to and subscribed before me this day of , . (Official Seal) Notary Public My Commission expires , 20 ToInstructions: Grantee/Provider should complete this certification for all funds received. Entity should enter appropriate data in the yellow highlighted areas. The completed and signed form must be provided to the Davidson County Department of Social Services. To: County Department of Social Services I I, Lexa Eagle, certify that Xxxxxx X. Xxxxx does I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. I 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. N.C.G.S.) 143C-10-1b. Xxxxxx X. Xxxxx I, Lexa Eagle, being duly sworn, say that I am owner and manager an independent contractor of Xxxxxx X. Xxxxx, a professional association engaged in the practice of law in Wallburg Davidson County DSS in the State of North Carolina and that the foregoing certification is true, accurate and complete to the best of my our knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Xxxxxx X. Xxxxx Lexa Eagle Date STATE OF County I, , certify that personally appeared before me this day and acknowledged the execution of the foregoing document(s) and being duly sworn to (or affirmed) by me that said document was signed by him/her in front of me. Witness my hand and seal this the day of . Sworn to and subscribed before me on the day of the date of said certification. My Commission Expires: (Notary Signature and Seal) 1 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. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement.” nonprofit’s objective. Another option is to apply for a 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax-free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition of tax-exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and nonprofit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. How does a Private Non-Profit obtain Tax Exempt Status? EO Web Site [ xxx.xxx.xxx/xx] You may direct technical and procedural questions concerning charities and other nonprofit organizations, including questions about your tax-exempt status and tax liability, to the IRS Tax Exempt and Government Entities Customer Account Services at (000) 000-0000 (toll-free number). If you prefer to write, you may write at: Internal Revenue Service Exempt Organizations Determinations P.O. Box 2508 Cincinnati, OH 45201 You may also contact the Taxpayer Advocate Service, an independent organization within the IRS that helps taxpayers resolve problems with the IRS and recommends changes that will prevent problems. A private nonprofit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax-exempt status is granted, the private nonprofit applies for State tax exempt status by completing Form CD-435 and submitting it to the N. C. Department of Revenue. • Article 2 of Chapter 64: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf • G.S. 133-32: xxxx://xxx.xxxx.xxxxx.xx.xx/gascripts/statutes/xxxxxxxxxxxxx.xx?statute=133-32 • Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009): xxxx://xxx.xxxxxxxxxxxxxxxx.xx.xxx/library/pdfs/Laws/EO24.pdf • G.S. 105-164.8(b): xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105- 164.8.pdf • G.S. 143-48.5: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 48.5.html • G.S. 143-59.1: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.1.pdf • G.S. 143-59.2: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143- 59.2.pdf • G.S. 143-133.3: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143- 133.3.html • G.S. 143B-139.6C: xxxx://xxx.xxxx.xxxxx.xx.xx/EnactedLegislation/Statutes/PDF/BySection/Chapter_143B/GS_143B- 139.6C.pdf
(1) Pursuant to G.S. 133-32 and Executive Order No. 24 (Xxxxxx, Gov., Oct. 1, 2009), the undersigned hereby certifies that the Contractor named below is in compliance with, and has not violated, the provisions of either said statute or Executive Order.
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