18-10 Contract

COUNTY OF ESSEX CERTIFICATION OF PAID OR OUTSTANDING REAL ESTATE TAX, WATER, AND/OR SEWER OBLIGATION N/A am the duly authorized representative of (Name of Individual) in connection with a proposed contract with the County of (Name of Firm) Essex to provide the goods/services described on paye 2 of this document for the contract period identified on page 3. and Thereby state that I have reviewed the records of. determine that there ( ) are, ( ) are not outstanding charges due and owing for real estate taxes, water and/or sewer costs. If there are outstanding obligations owed, state amount, and dates below: I certify that the aforestated representation is true and accurate. Name and Title:__Joseph A. Fonzino, Director/Health Officer Signature: LAC Date: __01/