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N. C. FIREgEN'S PENSION FUND <br /> <br /> ANNUAL CERTIFICATION OF FIREI~EN <br /> <br /> General Slalutes, Chapler ! 18-23, requires lhnt all cerlified lire departments cert/fy annually <br /> Io the Norlh Carolina Firemen's Pension Fund a complele roster o[ ils qaalilied firemen. <br /> <br /> The [ollowing cerlilicalion along with a complete roster of all active firemen* as of Jane 30 <br /> of each year taus! be submitted to tie North Carolina Firemen's Pension Fund, 116 W. Jones <br /> Street, Raleigh, North Carolina on o~ before July 30~. Failure to submil this cedificafion <br /> along.wilh a complete mst~ will ~es~ll in ~e loss of the death ~nefit pr?ided b~' the S~te. <br /> <br /> CERTIFICATION <br /> <br /> We, the C.c:ba't'~s Co~n%7 Cc,'~6nissione-~ <br /> <br /> in our capacity as Ihe ~overning ~dy of the Fire Depart- <br /> merit, cetdfy [hat we have examined end find that attached roster is a ir0e and accurate list of <br /> <br />t all aclive firemen* ofthe~ ~ ~ FireDepar~enl <br /> City of County of ~am~ , <br /> North Carolina. g'e further certify that lhe firemen lisled on lbo roster have completed at least <br /> 36 bores o~ meetings and drills during the prewous year. <br /> <br /> SIGNED: <br /> <br /> TITLE: <br /> <br /> DATE: <br /> <br /> ROSI[R L',tiSl BE ATTACHED WITH NAMES IN ALPHABETICAL ORDER. <br /> <br /> * I"irem:.n on aUt, oHzed "Leave of Absence me Io be included on the rosier. <br /> <br /> <br />