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Maximum Benefit Worksheet <br /> Pequot Lakes Fire Relief Association <br /> 1. Indicate your plan type here: I Lump Sum 1 <br /> 2. Enter data in columns A, B, C and D for each year requested. <br /> _ A B C D E <br /> ----------------- --------------------- -------------------- ------------------- -------------------- <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-03) (From RF-03) (SC-03 or Actuarial) (From RF-03) <br /> 2003 25,083 26,264 0 24 2,139 <br /> (From RF-02) (From RF-02) (SC-02 or Actuarial) (From RF-02) <br /> 2002 18,581 22,224 0 26 1,569 <br /> (From RF-01) (Fran RF-01) (SC-01 or Actuarial) (From RF-01) <br /> 2001 15,753 18,455 955 25 1,407 <br /> *If deficit for the year,leave blank. <br /> �. Average available financing per active member for the most recent 3-year period: 1,705 <br /> (sum of column E divided by 3) <br /> Maximum Lump Sum Benefit Level under Minn. Stat. §424A.02,subd.3 3,100 <br /> Maximum Monthly Benefit Level under Minn. Stat. §424A.02, subd.3 N/A <br /> ............................................................................................................................................. <br /> Relief Officer Certification <br /> On or before August 1,the average amount of available financing per active member for the most recent three- <br /> year period was calculated in accordance with Minn. Stat. §424A.02,subd.3,and certified to the governing `J�i <br /> body of the applicable qualified municipality. A &� <br /> w 60 /w <br /> Signature of Relief Association Officer Date <br /> — / 6 M&S kt1- <br /> Print Name and Title <br /> Please retain a copy of this form and return the signed original to:State Auditor's Office,Pension Division,525 Park Street, <br /> Suite 500,Saint Paul,MN 55103. Fax:(651)282-5298 Phone:(651)282-6110 <br />