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EXllIl3IT A <br />r~ <br />L <br />CERT I ~i I CAT IOi~t <br />The undersi~nec~ hereby certify that HENP.Y J. DACHTERA., <br />Social Security a!- 474-~1-4704, died on August 25, 1976, while <br />oai duty as a regularl;r en.rolLed member of the Falcon Heights <br />Voltznteer. F;.x? ~^r?.xtr~ert . <br />':'his Certif_cation is rlade ~o comply with the <br />requirements of :~Zi~znesota Statute § 352E.r04, otherwise known <br />as the "Peace Officers Fsenefit Acct." <br />He is survived by :~-:is widow, Ruth rI. Dachtera, <br />who has applied for ar_ receivAd workers' com-oensation benefits <br />occasioned by his d~~~th. <br />Ii <br />~~; =~_ <br />• ~ t7 ~q TI TR TOP. <br />Village of Falcon :eights <br />F,~.lcon :eights Fire Department <br /> <br />EXHIBIT A <br />,.-. <br />