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Nort#a Carolina State Firemen's Association 2 <br />P.O. Bog 188 <br />Farmville, NC 27878 <br />800-253-4733 <br />2002 <br />Ai~TNL? ~L CFRT'ICA'TI®I~1(3F F~EIVIEN <br />North Carolina General Statute 58-86-25 requires that all certified fire departments submit a complete raster of <br />its eligible firemen annually. '~'lais certified list determines eligibility for the 525,000 line-of-duty death <br />benefit as well as eligibility for Pension Fund credit. l:+'aila~re to accasrately and promptly r°port this <br />info~areation is violation oi' G.S. 58-86-2j and °~iil a.a~tamatically result in a loss or reda~c.#io~a cf he:~eiits. <br />~PD~T B~' ~'1T~ DFPA~T~IFN~' C~~F <br />As sire Department Chief, I have determined that 7.he attached roster is a valid and accurate list of all eligible <br />firemen, within the definition contained in North Carolina General Statute 58-86-25. <br />Name of Fire Department Orange County Fire Marshal's Office <br />Fire Department Mailing Address P . 0 . Box 8181 <br />City Hillsborough <br />Name of Fire Chief <br />Stale N.C. <br />Mike Tapp -Fire Marshal <br />din Code 27278 <br />(P?ease print or ~-pe) <br />Signature of Fire Chief ~yYtM~t.C. ~'T~„/~ <br />Date December 10, 2002 Daytime Telephone _{ 9191 968-2050 <br />County Orange <br />C~P~Ti_FIC<~:TIGN BY ~D4'~~'~Tr'NG BG~:~? <br />Pursuant to G.S. 58-86-25, the governing body of a fire department operated by (i) a county is the county board <br />of commissioners, (ii) a city is the city council, (iii) a sanitary district is the sanitary district board; {iv) a <br />corporation, whether profit or nonprofit, is the corporation's board of directors and {v) any other entity is that <br />group designated by the board. Therefore, in our capacity as the governing body of the above-named ~ re <br />department, we certify and find that the attached roster is a valid and accurate list of all eligible Bremen in <br />accordance with G.S. 58-86-25. <br />Name of C=overning i3ody <br />dame of Governing Body Gfficial <br />Authorized Signature <br />Barry Jacobs <br />{Please print or type) <br />Title Chair, Board of Commissioners <br />Orange County Board of County Commissioners <br />Date ~~~~m~ieF ~0 ; 2002Daytime Telephone( 919 732-8181 <br />