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pew OP Street Address(Station 1): Mailing Address: 5 <br /> 4012 Whitfield Road P.O.Box 16484 <br /> .4 ° Chapel Hill,NC 27514 Chapel Hill,NC 27516 <br /> Phone:(919)493-1001 www.newhopefire.com <br /> Fax: (919)419-0241 <br /> New Hope Volunteer Fire Department of Orange County, Inc. <br /> Structure Release <br /> County, North Carolina <br /> (We), , being the owner of the real <br /> property located at , do hereby grant <br /> permission to the Chief of the New Hope Fire Department to set fire to <br /> and burn the structure(s) located at the address above and described <br /> herein for the purposes of live fire training. I (We) certify that there is no <br /> insurance coverage on the described structure(s) and do hereby release <br /> all claims connected with or which may occur out of the setting fire to and <br /> burning the structure(s). The structure will be burned down to its <br /> foundation. Any chimneys that have not come down as a result of the <br /> burn will remain as is. The located property will be released to the above <br /> owner(s) at the completion of the live fire training when all New Hope <br /> Fire Department units have been cleared from the scene. Property <br /> Description: <br /> Single family residential dwelling with accompanying sheds to the rear of <br /> the house <br /> Owner Owner <br /> I, , Notary Public of said county, do hereby <br /> certify that personally appeared before me <br /> this day and acknowledged the execution of the foregoing instrument. <br /> Witness my hand and seal, this the day of , 20 <br /> Notary Public <br /> My Commission Expires <br />