Agenda - 05-03-2005-5g - Laserfiche WebLink

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North Carolina State Firemen's Association P.O. Box 188 Farmville, NC 27878 800-253-4733 2004 ANNUAL CER'TTFICATION OF FII2EMEN North Caolina General Statute 58-86-25 requires that all certified fue departments submit a complete roster of its eligible firemen annual]y. This certified list determines eligibility for the X50,000 tine-of duty death benefit as well as eligibility for Pension Fund credit. Failure to accurately and promptly report Ibis information is violation of G.S. 58-86-25 and will automatically result in a loss or reduction of benefits. REPORT BY FIRE DEPARTMENT C'ffiEF As Fue Depaztment Chief, I have determined that the attached raster is a valid and accurate list of all eligible fuemen; within the definition comained in North Carolina General Statute 58-86-25 NameofFireDepartment Orange County Fire Marshal's Office Fite Department Mailing Address P.0. Box 8181 _ _~ City` Hillsborough - State N.C. _,Zip Code 21278 Name of Fire Chief Mike Taop~_Fire Marshal __- (Pleaseprint or type) Signature of Fire Chief__~~/(,[~.Y, Pte' _-- Date April 18, 2005 Daytime Telephone _( 919) 968-205D County Orange CIItTIEIC'ATION BY GOVERNINGBODY Pursuant to G:S 58-86-25, the governing body of a fire depaztment operated by (i} a county is the county boaz'd of commissioners, (ii} a city is the city council, (iii) a sanitary district is the sanitary district boazd, w) 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 ofthe above-named fue 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 Oranga County Board of Commissioners Name of Governing Body Official __ MoG ~ .ar .y (Please print or type) Authotized Signature Title ['ha;r Date_ May 3, 2005_DaytimeTelephone_( 91 732-8181 ~-_