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OFFICER'S CERTIFICATION (Form must be provided to municipal clerk on or before August 1, 1995) the officers of the &4-E — �GMD Firefighters Relief Association, state that the accompanying sl--,dules have been prepared in accordance with the provisions of Minn. Stat. § 69.772, subd. 4. The average amount of available financing per member of the special fund for the past three years is . Further, benefit levels have been established in accordance with the average amount of available financing, as is required by Minnesota law. We certify that the financial requirements of the relief association special fund for 1996 purposes of required municipal contribution is $ /t .T`/& President Signature of Secretary tgnatur' of Treasurer Date Date L / S rzf' Date CLERK'S CERTIFICATION 41a the cl rk of I have received the completed Office of State Auditor ScheduleI&II from Zv Relief Association on1995. I have reviewed Section 2, line 8, 12 and 18 chedule II. 'If line 12 or 18 reflects a require municipal contribution, I certify that I will advise the governing municipal body at it's next regularly scheduled meeting. If the Certification of the Officers discloses that the By—laws have been amended or benefits have increased and lino 12 or 18 reflect a required municipal contribution, I certify that the governing municipal board passed a resolution approving of the increase or change in by—laws. I have attached the Board resolution, if required. Dateo7d �A�!/lI2lt Signatur of Cler Bus ess Phone WARNING: 7his document must be fully completed, cerkfted by the relief association officers, certified by the municipal clerk and filed with the Oil= of State Auditor reporting form as required by Minn. Stat. §69.771. subd. 3. Failure to file this document, whether or not a municipal contribution is due, will result in inehl iflbility of state fire aid, as required by Minnesota state law. Page 5