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STATE OF NORTH CA;(OLIf,~A DEPARTMENT OF STATE ALJ[,ITOR ANNUAL CERTIFICATION OF FIRmaN 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. 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 Cabarmus Boamd of Commissioners in our capacity as the governing (Governing Bod~Y body of the Geo~gvi!le Fire Department, certify that we have examined and find that attached ~s a true and accurate list of all active firemen* of the ~eo~gvil!e Fire Department, address R~, 1 S%anfield 2818~ County of Cabarrus , North Carolina. Signed Title Date For Fire Department Chief .Only ueparrmenr, certify [ne-xlj~rcacneo roster ~s a true and ah~cur~g list of all eligible fire- men. (Eligible fireme~z~e firemen who have met the required 36 hours of meetings and drills during the last/cglendar ),ear (July 1 - June 30). In addition, the term "eligible firemen" shall mean those firemen who have joined the fire department 'within the calendar gs drills.) year and are in the process of completing the required 36 hour~f ~n. and ROSTER MUST BE ATTACHED WITH NAt{ES IN ALPHABETICAL ORD8R. *Firemen on authorized "Leave of Absence" are to be included on the roster. kq~enever a new fireman is added to the roster during the year, hi~ or her ~mne should be fom~ard to the Pension Fund Office imzaediatel~.