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7 <br />2013 Maximum Benefit Worksheet (MBW-13) <br />Plan Name: <br />Plan Type: Lump Sum <br />Pequot Lakes Fire Relief Association <br />Enter data in columns A, B, C and D for each year requested. <br />2012 <br />2011 <br />A B C D E <br />State Fire Aid � Active Members Per Year <br />(Received or Municipal 10% of in Relief Average <br />Receivable) Contribution Surplus * Association [(A + B+ C) / D] <br />(From RF-12) (f'rom RF-12) (SC-12 or Actuarial) (From RF-12) <br />35,012 54,556 10,792 26 3,860: <br />(From RF-1 ]) (From RF-I ]) (SC-11 or Ach�uial) (From RF-11) ' <br />34,540 44,124 19,839 29 3,397 <br />(From RF-10) (From RF-10) (SC-10 or Actuarial) (From RF-]0) <br />2010 28,803 57,083 13,743 29 3;435 <br />* If deficit far the year, leave blank. <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 <br />Relief Officer Certification <br />�, 3,564 __ i <br />I 6,600 <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 />r r�- £�, .��,. <br />L � � ��: t __ _ -:�; <br />7j . <br />� ��.. <br />"_ ' _ '_""_"''_'-__"' _"______-__ _' _�Rti��f�1��J--�e �� fT_^i^ t,� _'_-_'__-"__-_ ___'-_____-_ ___'-__ <br />-. �,{f <br />SignaYureofReliefAssociationOfficer`e'"�'"' �"'`;`-' �=-,,�: �1*. �;;:s Date <br />7� 3�..�. ,:;�, ^` . <br />3 iCSL#J��...._.e_i$, ��.4` a(-f?7 <br />' _ _" �'V "/ <br />First Name Last Name Title <br />