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STATE OF NORTH CAROLINA DEPARTMENT OF STATE AuotTOR FIREMEN'$ AND RESCUE SQUAD WORKER'S PENSION FUND DIVISION ANNUAL CERTIFICATION OF FIREMEN General Statutes, Chapter 118-23, requires that all certified fire departments Certify annually to the N. C. Firemen's Pension Fund a complete roster Of its qualified firemen. The following certification along with a complete roster of ali active firemen* as of June 30 of each year must be submitted to the N. C. Fireman's Pension Fund, 116 W. Jones' St., Raleigh, N. C. on or before July 3li. Failure to submit this certification alon~ with a complete roster will result in the loss of the death benefit provided by the State. CERTIFICATION We, the CabaC~us County Board of Commissioners in our capacity as the governing (Governing Body) b~dy of the Jackson Park Fire Department, certifY that we have examined and find'that attached is a true and accurate list Of all active firemen~ of the ' Jackson Park Fire Department, address 591 Jackson Terrace County of Cabarr~s , North Carolina. Concord Title Date For Fire Department Chief Only I, David L. Clay , Chief of the Jackson Park Fire Department, certify the attached roster ~s a true and accurate list of all eligible fire- men. (Eligible firemen are firemen who have met the required 36 hours of meetings and t, drills during the last calendar year (July 1 - June 30). In addition, the:term "eligible firemen" shall mean those firemen who have joined the fire department within the calendar year and are in the process of completing the required 36 hours of meetings and drills.) Fire Chief / ~ Date ROSTER MUST BE ATTACHED WITH NAMES IN /LLPHABETICAL ORDER. *Firemen on authorized ',Leave of Absence" are to be i~cluded on the roster. Whenever a new fireman is added to the roster during the year, his or her name should be lombard to the Pension Fund Office in~nediatel~.