Agenda - 06-27-2006-5v - Laserfiche WebLink

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North Carolina State Firemen's Association P.O. Box 188 2 Farmville, NC 27828 800 - 253 -4733 2005 ANNUAL CERTIFICATION OF FIREMEN North Carolina General Statute 58 -86 -25 requires that all certified fire departments submit a complete roster of its eligible firemen annually. This certified list determines eligibility for the $50,000 line -of -duty death benefit as well as eligibility for Pension Fund credit. Failure to accurately and promptly report this information is violation of G.S. 58 -86 -25 and will automatically result in a loss or reduction of benefits. '�' : 1' 1 '• I II1 As Fire Department Chief, I have determined that the attached roster is a valid and accurate list of all eligible firemen, within the definition contained in North Carolina General Statute 58- 86 -25. Name of Fire Department Orange County Fire Marshal's Office Fu e Department Mailing Address City Hillsborough State Zip Code 27278 Name of Fire Chief Mike Tapp, Fire Marshal - (Please print or type) Signature of Fire Date June 8, 2006 Daytime Telephone _ 9( 19 ) 968 -2050 County Orange CERTIFICATION BY GOVERNING BODY Pursuant to G.S. 58- 86 -25, the governing body of a fire department operated by (i) a county is the county board of commissioners, (ii) a city is the city council, (iii) a sanitary district is the sanitary district board, (iv) a corporation, whether profit or nonprofit, is the corporation's board of directors and (v) any other entity is that group designated by the board. Therefore, in our capacity as the governing body of the above -named fire department, we certify and find that the attached roster is a valid and accurate list of all eligible firemen in accordance with G S.58- 86 -25. Name of Governing Body Orange County Board of County Commissioners Name of Governing Body Official Barry y, Jacobs, Chair (Please print or type) Authorized Signature Title Chair Date Daytime Telephone_ 919 245 -2130