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DiSTRiCT ~$ SERV ed BY .'//~ 1/~__~ FI RE DEPARTMENT <br /> <br />N()TI':: This i't. Dort nlllst I}e filled mil ¢Omlfiutvly. nuiat be ~ignml ;tlHl sWOrll to. and i,UtUl'llt'd lo the ] ~ll.;lllce D6Darlmunt before <br />Ochfl)er :tlst. or the rice dt.p:trtment will lose their I):LrtofLhel''iremen's Ileliuf l~und tax for this yeav.--InauranceCommias~oncr. <br /> <br /> NORTH CAROLINA <br /> <br /> RURAL FIRE DISTRICT <br /> <br /> REPORT OF FIRE CONDITIONS <br /> <br /> AS I'{q[llil'('fl I)~I ~(T{:[i(Tll I l~'~) O[ tap (;QBCI'[[I ~t~[[[l[~~S o[ North (]arl)lilllt. 1. Au(litor of sai(I Cotilll~ (lO hereby make <br />the folh,win~ rtq,m:t on the ~ ~ ~/ District. County of ...~J~f~ .................. <br /> FIIIE DIgPAI~TMENT [NFOITMATION <br /> <br /> No. l.'.D. Houses or Stations .......... ~ ................. No. PunlDtTS ......... I ........................ <br /> <br /> No. Other 81meial Purlmse Vehicles --..~ .......... <br /> "vpe Water 8u } fly: Mohile .................................. Hyt r nts .............. ~- .............. Combination .. ~ ............. <br /> <br /> LOCAL FIRIgMEN'S REIAEI" FUND <br /> <br /> N ,,,,~ ,ff qh usleos of 1" 'e hen's Relk I' l~t n t ~pointed I y ~ 'e Delmrtment (twol ..................................................... <br /> <br /> appointed by t w Cotmtv Conmiissioners {two) ...................................... <br /> Names of Trustees of I,'ivemen's Relief Fund , <br /> <br /> Names of Trustee of Firemen's Relief Fund appointed by I nsm'ance Commission0r (one) .......................................... <br /> I ~ sanw ;us hust year. check here ( <br /> lh.easurerofFiren~c~slleliefFumlNumber./ I '2 ~ ,I 5 Al~ove~encirelcwhich) ~.~. <br /> ls your Fire De ml'tlnent a member of thc North C;trotin;t State 1,'iremt'n's Association? ............................... <br /> <br /> NORTII CAROLINA <br /> .................................................. County. <br /> ....................................................................... Auditor/Finance officer of .................................................................... <br /> Cotlnty. N. G. do he~'eby certify that the fm'e~oing is a true. full. nmi correct report of the Fire Department and fire <br /> conditimm or ............................................ llural Fire Dis(tier. <br /> Under Section 118-9 of the General Statutes of North Garoli,a. <br /> <br /> Sworn to ami subscribed beftn'v me, this .......................................... day of ........................................... 19 ............ <br /> <br /> ISEAI,] <br /> NOTE: This report can not be accepted unless sworn to before a Notary or other officer with Seal. <br /> <br /> <br />