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STATE OF NORTH CAROLINA DEPARTMENT OF STATE AUDITOR ~ FIREMEN'S. AND RESCUE SQUAD WORKER'S PENSION FUND DIVISION ANNUAL CERTIFICATION OF FIREMEN General.Statutes, Chapter 118-38, requires that all certified fire departments certify annually to the N. C. Firemen's Pension Fund a complete roster of its qualified firemen. The following certification along with a complete roster of all active firemen* as of June 30 of each year must be submitted to the N. C. Firemen's Pension Fund, 300 No 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 Cabarrus Co. Board of Commissioners in our capacity as the governing (Governing Body) body of the Jackson Park Fire Department, certify that we have examined and find that attached is a true and accurate list of all active firemen* of the Jackson Park Fire Department, address 591 Jackson Terrace County of Caba~us, North Carolina. Concord, NC ZHO2b Signed Title Date For Fire Department Chief Only Department, certify the attac~ roster is a true and ~c~rake llst df all eligible fire- men. (Eligible firemen arefire men who have met the required 36 hours of meetings and drills during the last calendar year (July 1 - June 30). In addition, the term "eligible firemen" shall mean those firemen who have joined the fire department within the calendar year and are in the process of completing the required 36 hours of meetings and drills.) Fire Chief Date ROSTER MUST BE ATTACHED WITH NM(ES IN ALPHABETICAL ORDER. *Firemen on authorized "Leave of Absence" are to be included on the roster. %~henever a new fireman is added to the roster during the year, his or her name should be forward to the Pension Fund Office hunediately.