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5co-, 11 PACE 529 0 <br />STATE OF NORTH CAROLINA <br />DEPARTMENT_OF_ STATE AUDITOR - <br />FIREMEN'S AND RESCUE SQUAD WORKER'S PENSION FUND DIVISION <br />300 N. SALISBURY STREET <br />RALEIGH, N. C. 37011 <br />z ANNUAL CERTIFICATION OF FIREMEN <br />ti <br />General Statutes, Chapter 118-38, requires that all certified fire departments certify <br />annually to the N. C. Firemen's Pension Fund a complete roster.of its qualified'ifiremen. <br />The following certification along with a complete roster of all"'a"ctive firemen*..as of.- <br />June-30'-of each year must be submitted to the N. C. Firemen's Pension Fund; 3010 N. Salisbury <br />St., Raleigh, N. C. on or before July 31.a Failure to submit this certification'aTong_ <br />with°-a complete roster will result in the loss of the death benefit provided by the State.. <br />CERTIFICATION <br />For Fire Department Chief Only <br />1, Robert A. Jones Chief of the Cape Fear Fire <br />Department, certify the attached roster is a true and accurate list of all eligible °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 who have joined the fire department within the calendar <br />year and are in the process of completing the re re hoursqf f meetings and drills.) <br />i A CCLL////~. <br />Fire Chief <br />14 July 1984 <br />Date <br />ROSTER MUST BE ATTACHED WITH NAMES IN ALPHABETICAL ORDER. <br />We, the, in our.capacity__.as the governing <br />Governing Body _ <br />body of the Fire Department, certify'ttiat we have examined <br />and finHdtc at attached`is°a true and accurate list of all active firemen* of the <br />- Fire Department, address county of <br />North Carolina. <br />Signed <br />Title <br />Date <br />*Firemen on authorized "Leave of Absence" are to be included on the roster. <br />Whenever a new fireman is added to the roster during the year, his or her name should be <br />forward to the Pension Fund Office immediately. <br />