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NAME OF F;RE DISTRICT Y)/~/~ ~)/~ ' i <br /> <br /> NO'I'I';: This report must be filled out completely, must be signed ami sworn to. and returned to the Insurance Department before <br /> <br /> RURAL FIRE DISTRICT <br /> <br /> To 'l'lllC COMMISSIONER Cl.' INSURANCE. <br /> Raleigh, N. C. <br /> <br /> As 'e I{ 'ed by secliun 118-[) of the Geueval Stu[utes of North Carolinu. I. Auditm' {flsa[ti County do hereby make <br /> <br /> I¢IRE DEPAI{TMICNT INFORMATION <br /> <br /> No. F.D. [lmmes or Statioos ......... / ...................... No. Pnml}eVs ........... ~ ...................N{}. Tankers .....~ .............. <br /> No. Otbm' Specinl Purpose Vehicles ....... ~. .................................................................. Totul Co's ....... ~. .................. <br /> T~'I}eW terSuppy Mobile ............... ~ .......... Hydrants ................................ Combination .............................. <br /> <br /> LOCAL I,'IRI,:MIgN'S RELII~Ia FUND <br /> <br /> Names ofTrustees~ ~of Fil'emen;~ Relief Fuml appifinted by Fire l)t, partlnent (t~¥o) ...................................................... <br /> <br />NamesofTrustcesoflCiremen'sRelicflCunda}mintu byt}eC ty~onmss ~ ers twb) ...................................... <br /> <br /> Names of Trustee of ICiremen's Relief l,'uod appoinied l)y I egm'ance Com~ssiouer (one) .......................................... <br /> <br />Treasurer oflCh'emen's ReliefFuud Nuo:uer. ~ 2 3 ,1 5 Above(encircle which) <br />Is y{ t · I,' I'e Department a member of tim North Caroliua State lciremen's Association? ..~/.~:~ ........................... <br /> <br /> NORTH CAROl,INA <br /> <br />....................................................................... Auditor/l,'inaude officer of ................................................................... <br />Cmioty. N. C. do hereby em'ti[' that the fore~oin~ is a t,'ue, fu II. and cmn'eeL tel}crt of the Fire Depm'tmenL and fire <br /> <br />conditions of ............................................ Rural loire I)istrieL <br />Under Section 118-9 of the General Statutes of Nm'th Cm'olina. <br /> <br /> Sworn to and subscribed before me. this .......................................... {Itkv of ........................................... 19 ............ <br /> <br />NOTIg: This repor[ can not ue accepted unless SWol'n to before a Notary or other officer with Seal <br /> <br /> <br />