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• <br /> 36.6 <br /> STATE DP" CAR7.; '.A <br /> DE P TMEN T STATE , : TDFIREMEN'S AND RESCUE SQUAD ".QRK ER'S FUND DWI 5iON <br /> 3CC, SALI55L:FIT 57RaEs. <br /> AL5l5H, .. C. 2”S I <br /> ANNUAL CERTIFICATION OF FIFEX-EN <br /> -- -4-- - <br /> GenQral Statutes, Chapter 116-23, requires that a:1 certified fire departments certify <br /> annually to the N. C. Firemen's Pension Fund a complete roster of i:s qualified firemen. <br /> the follo4inE certification along with a complete roster of all active firemen k as nf <br /> June 30 of e rh year must be submitted to the N. C. Firemen's Pension Fund, 115 W, jones <br /> St. , Raleigh, N. C. on or before July 31. Failure to sumiz this certificatior <br /> with a complete roster will result in the loss of the death benefit provided b' The State. <br /> CERTIFICATIO:; <br /> We, the in our capacity as the 2overning <br /> (Governing Body) <br /> body of the Fire Department, certify that we have <br /> and find that attached is a true and accurate list of all active firemsr, of the <br /> Fire Department, address County of <br /> , North Carolina, <br /> Slier ad <br /> title <br /> - ----- <br /> Date <br /> _-- <br /> For Fire Deoa-t-en, Chief Only <br /> /. • <br /> •'-)" 1 . <br /> , Chief of the Fire <br /> Department , certify the attached roster is a true and accurate list of all elignile-fire- <br /> men. (Eligible firemen are firemen who have met the required 36 hours of meetinzs and <br /> drills during the last calendar year (July 1 - June 30) . In addition, the term "eli3ible <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 required 36 hoL:rs of meetings and drills.) <br /> " 7 L.( <br /> Fire Chief <br /> — <br /> Date <br /> ;TER MUST 3E ATTACHED WITH NAJES IN ALPFA3ET1CAL ORDER. <br /> f'Firemen on authorized "Leave of Absence" are to be included on the roster, <br /> 14henever new fireman is added to the roster during the year, his or he: vlar . should be <br /> ton:are.! the Pension Fund Office <br />