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STATE OF NORTH cAROLINA DEPARTMENT OF STATE AUDITOR FIREMEN'S AND RESCUE SOUAO WORKER'S PENSION FUND DIVISION ANNUAL CERTIFICATION OF FIRE>fEN General Statutes, Chapter 118-23, 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, 116 W~ Oone$ St., Raleigh, N. C. on or before Jul~ 3l. Failure to submit this certification alon$ with a complete roster will result in the loss of the death benefit provided by the State. CERTIFICATION We, the Cabarrus County Board of Commissioners in our capacity as the governing (Governing Body) b~dy of the Cold Water Fire Department, certify that we have exgmined and find that attached is a true and accurate list of all active firemen* of the Cold Water Fire Department, address Rt. 5, Box 317 County of Cabarrus , North Carolina. Concord~ NC Signed Title Date For Fire Department Chief Only I, , Chief of the Fire Department, certify the attached roster is a true and accurate list of all eligible fire- men. (Eligible firemen are firemen 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.) ~ ~/~ Fir e Chief - / ~2~ Date ROSTER MUST BE ATTACHED WITH NA~ES IN ~P~BETIC~ ORDER. *Firem~n on authorized "Leave of Absence" are to be idcluded on the roster. ~enever a new fire~n is added to the roster duri~ the year, his or her ~me shonld be fom~,ard to the Pension Fund Office i~mediately.