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STATE OF NORTH CAROLINA <br /> DEPARTMENT OF STATE AUDITOR <br /> FIREMEN'S AND RESCUE SQUAD WORKER'S PENSION FUND DIVISION <br /> <br /> ANNUAL CERTIFICATION OF FIRF2~EN <br /> <br />General Statutes, Chapter 118-23, requires that all certified fire departments certify <br />annually to the N. C. Firemen's Pension Fund a complete roster of its qualified firemen. <br /> <br />The following certification along with a complete roster or'all active firemen* as of <br />June 30 of each'year must be submitted to the N. C. Firemen's Pension Fund, 116 W. Jones: <br />St., Raleigh,'N. C. on or before July.~l.. Failure to submit this certification along <br />with a complete roster will result in the loss of the death benefit provided by the State. <br /> <br /> CERTIFICATION <br /> <br />We, the _C~ka~ru$ County Board of C~nm~issioners in our capacity as the governing <br /> (Governing Body) <br />body of the Pitts Fire 0epa6tment, certify that we have examined <br />and find that attached is a true and accurate list of al! active firemen* of the <br /> Pitts Fire Department, address Pitts School Rd. County of <br /> Cabarrus , North Carolina, Concord <br /> <br /> Signed <br /> <br /> Title <br /> <br /> Date <br /> <br /> For Fire Department Chief Only <br /> <br />Department, cer~fy the attached 'roster is a true and accurate list of all ~-~e fire- <br />men. (Eligible firemen are firemen who have met the required 36 hours of meetings and <br />drills during the last calendar year (July 1 - June 30). In addition, the term "eligible <br />firemen" shall mean those firemen ~ho have joined the fire department within the calend~ <br />year and are in the process of completing the requi~d 36 hours of meetings and drills.) <br /> <br /> }:ire Chief <br /> <br /> })ate <br /> <br />ROSTER MUST BE ATTACHED WITH NAMES IN ALPHABETICAL ORDER. <br /> <br />*Firemen on authorized ~'Leave of Absence" are to be {nc'luded on the roster. <br />g~enever a new fireman is added to the roster during the year, his or her ~u~me should be <br />fom~,ard to the Pension Fund Office ieraediatelv. <br /> <br /> 7 <br /> <br /> <br />