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STATE OF '4ORTH CAROL./~'?-". DEPARTMENT OF STATE AUD~I'OR FIREMEN'S AND RESCUE SQUAD WORKER'S PENSIOI', FUND DiViSION ANNUAl, CERTIFICATION OF FIREI.~N Genera] Statutes, Cbapcer 118-23, requires that all certified fire departments certify annually to the N. C. Firemen's Pension Fund a complete roste~ 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. Fireman's Pension Fund, 116 W. Jones St., Raleigh, N. C. on or before July 31. 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 CabamPus BoaPd of Commissionems in our capacity as the governing (Governing Body) body of the Kannapolis Village Fire Department, certify that we have examined and find that attached ts a true and accurate list of all active firemen* of the w' Fire De artment, address Church St. ~a~nJpeiis .~.lg~. P County of Caba~rus _, North Carolina. Kannapolls 98081 -- Signed Title Date For Fire Department Chief Only I, Paul g. Hudson , Chief of the Kannapolis Village Fire Department~ certify the attached roster ts a true and accurate list of all eligible fire- meu. (Eligible firemen are firemen who have me~ 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~,~red 36 bouts of meetings and drills.) '- / Fire Chief Date ROSTER MUST BE ATTACHED WITH NAMES IN ALPHABETICAL ORDER. *Firemen on authorized "Leave of Absence" are to be included on the roster. %~enever a new fireman is added to the roster duri~ the year, his or her name should be ronsard to the Pension Fund Office immediately.