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2015 Maximum Benefit Worksheet (MBW-15) <br /> Plan Name: Pequot Lakes Fire Relief Association <br /> Plan Type: Lump Sum <br /> Enter data in columns A, B, C and D for each year requested. <br /> A B C D E <br /> — <br /> ^ Active Members Per Year <br /> Fire State Aid and <br /> Supplemental State Municipal 10%of in Relief Average <br /> Aid Contribution Surplus* Association [(A+B+C)/D] <br /> (From RF-14) (From RF-14) (SC-14 or Actuarial) (From RF-14) `'3 i," <br /> i fi <br /> 2014 45,390 46,629 27,894 31 `` psi <br /> (From RF-13) (From RF-13) (SC-13 or Actuarial) (From RF-13) • <br /> xe <br /> 2013 47,129 46,046 14,279 26 1A " . <br /> (From RF-12) (From RF-12) (SC-12 or Actuarial) (From RF-12) _ . t <br /> 2012 35,012 54,556 10,792 26 _ ,7, Pt0ao :; <br /> *If deficit for the year,leave blank. <br /> ,,. � 1 <br /> Average available financing per active member for the most recent 3-year period: + ' <br /> (sum of column E divided by 3) <br /> Maximum Lump Sum Benefit Level under Minn. Stat. § 424A.02,subd. 3 ..4--,7,:X.#1$45..:47411.' <br /> Relief Officer Certification <br /> On or before August 1,the average amount of available financing per active member for the most recent <br /> three-year period was calculated in accordance with Minn. Stat. § 424A.02, subd. 3, and certified to the <br /> governing body of the applicable qualified municipality. <br /> CLIENT COP\' <br /> math/as C. Justin, Ltd. <br /> Cersifipri Pu9,'•iCAc'ountatlt3 <br /> Signature of Relief Association Of ggraresident,Secretary,or Treasurer) Date <br /> Pequot Lakes.MN 56472 <br /> First Name Last Name Officer Title <br />