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STATE (~F~ NORTH CAROLINA DEPARTMENT OF STATE AUDITOR FIREMEN'SoAND RESCUE SQUAD WORKER'S PENSION FUND DIVISION ANNUAL CERTIFICATION OF FIREHEN General Statutes, Chapter 118-38, requires that all certified fire departments certify annually to the N. C. Fireman's Pension Fund a complete roster of its qualified firemen. The folloving certification along with a complete roster of all active firemen* as of June 30 of each year must be Submitted to the N. C. Fireman's Pension Fund, 300 N. Salisbury St., Raleigh, N. C. on or before July 31. Failure to submit this certification along with a complete roster will result in the loss of the death benefit provided by the State. CERTIFICATION We, the Cab~rrus County Board of Con~nissioners in our capacity as the 8overning (Governing Body) body of the Poolar Tent Vol. Fire Departmen% certify that we have examined and find that attached is a true and accurate list of all active firemen* of the Poplar Tent V~I Fire Department, address 3}0 POpIsFTent Rd. County of ~absrrus , North Carolina. Concord N C 2802q Signed Title Date For Fire Department Chief Only l, Carl Wm Caldwell , Chief of the Poplar Tent Vol. Fire Department, certify the a~tached roster is a true and accurate list of all eligible fire- men. (Eligible firemen are firemen ~ho have met the required 36 hours of meetings and drills during the last calendar year (July I - June 30). In addition~ the term "eligible firemen" shall mean those ~iremen who have joined the fire department within the calendar year and are in the process of completing the ~q~yed 36 hours o~in~s and drills.) '/ ~ Dace ROSTER ~Sl' BE ATTACHED ~ITH ~S 1N ~P~TIC~ ORDER, aFi~emen on authorized "Leave oI Absence" are to be iacluded on ~he roster. t,~enever a ne~ fira~n is added to the roster duri~ the year, his or her ~ should ~ fo~ard ~o the Vension Yund O[[ice ~diately.