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N. C. FIRE~IEN'S PENSION FUND <br /> · DIVISION <br /> DEPARTMENT OF STATE AUDITOR <br /> <br /> RALEIGH, N. C. 27~03 · <br /> <br /> ANNUAL CEI~TIFICATION OF FI~EUEN <br /> <br />General Statutes, Chapter 118-23, requires that all certified fire departments certify annually <br />to the North Carolina Firemen's Pension Fund a complete roster of its qualified firemen. <br /> <br />The following certification along with a complete roster of all active firemen* as of ]nne 30 <br />of each year must be submitted to the North Carelifla Firemen;s Pension Fnnd, 116 W. Jones <br />Street, Raleigh, North Carolina on or before July 30th. Failore to submit fllis certification <br />along.with a complete roster will result in the loss of the death benefit provided by the State. <br /> <br /> CERTIFICATION <br /> <br />We, the <br />in oor capacity as the governing body of the Fire Depart- <br />ment, certify that we have examined and find that attached roster is a t~ae and accurate list of <br />all active firemen* of the Fire Department, <br /> <br />City of County of , <br /> <br />Nortb Carolina. [~/e fl~rther certify that the firemen listed on the roster have completed at least <br />36 hours of meetings and drills during the prewous year. <br /> <br /> SIGNED: <br /> <br /> TITLE: <br /> <br /> DATE: <br /> <br /> ROSIER MUST 8E ATTACHED WITH NAMES IN ALPHA§EIICAL O[IDER. <br /> <br /> Firemen on authorized "Leave of Absence" are to be included on the roster. <br /> <br /> -7 <br /> <br /> <br />