Laserfiche WebLink
DISTRICT <br /> <br /> M ail To The Nerth Carolina State Department of ! nsurance. P. O. Box 2(;:}87. R~tleigh, N. C. 27(;11--Before ()c(oher ;iisi. <br /> <br /> NOTE: This report must be filled out completely, must be signed and sworn to, and rehn'ncd to thc Insurance l)bPar tment before <br /> Odoher :11 st. or the fh'e department will lose their part of the Firemen's Relief Fund tax for this ye~r.~Insurnnce Commissioner, <br /> <br />  NORTH CAROLINA <br /> RURAL FIRE DISTRICT <br /> <br /> . REPORT OF FIRE CONDITIONS <br /> <br /> To Till.: COMMISSIONER OF INSURANCE, <br /> Raleigh, N. C. <br /> <br /> As required by section 118-9 uf the General Statntes of North Car{}linn, l, Auditor uf said County do hereby make <br /> the <br /> <br /> FIRE DEPARTMENT INFORMATION <br /> <br /> No F.D. House, or StaLJo,s .............. ~ ................. ~o. ~tlmper~ ........ ~ ..................... No. T,,kers .....~. ................ <br /> No. (iL ~e' Spec a '~ · )use vet c es ......... .~. ............................................................. Total Co's ....~ ...................... <br /> Type Waler Supply: Mobile ..................................HydrunLs ................................ Comb~naL~on ..~ .................. <br /> <br /> LOCAL FIREMEN'S RELIEF FUND <br /> <br /> Numcs~ ~ .//__n~Trus~ecs o~ Fi~m~'s R~l[of F.nd uppoinLed by Fire Dcpariment (two) ...................................................... <br /> <br /> Names of Trustees o~il'e~ieu's ~el~e[ F~fld appo~nLed by Lbo CouitW Comm~ssJo~ers (Lwo) ..................................... <br /> <br /> Names o~'l'~ustee o[ Fh'emen's Relief Fund appo[oLed by Insurance Corem [ssionnr (o.~) .......................................... <br /> <br /> A. Mr. ....................................... [fsame ;m I~L year, cheek here/' <br /> Treu~urerofFiremen'sRelie~umlNumber, 1 ~,1 5 Above(enei~'elewhieh) <br /> is yo~ r Fire DeparLmenL ~ member {ff the NnrLh Carolina 8~a~e Firumen's As.o~iaLion?~,~: .............................. <br /> / <br /> NORTII CAROLINA <br /> .................................................. County. <br /> <br /> ....................................................................... Auditnr/Finance officer of .................................................................... <br />County, N. C. do hereby certify ~hat lhe fore~oin~ is a ~rue, full. und corrcct rcpor~ of the Fire Department and fh'c <br /> <br />cun{litions nf ............................................ Rural Fire District. <br />Under Section 118-9 of ~he General StuLutes of North Cu~olina. <br /> <br /> Swnro [o nnd subscribed before me, this .......................................... {hw nf ...... ' ..................................... 19 ............ <br /> <br />ISEAL} ........................................................................................... <br />NOTE: This report can no~ be ncecptcd unless sworn to before a Nolnry or o~her officer with SeM. <br /> <br /> <br />