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Form SC-04 PEQUOT LAKES / Page 1 a <br /> L Relief Association jPequot Lakes Fire Relief Association County Crow Wing <br /> Annual benefit level in effect for 2004 2,500 <br /> (If you change your benefit level before 12/31/04,the SC must be recalculated at the new level.) <br /> Active Member Information -continued <br /> Fire Dept. Leaves To end of 2004 To end of 2005 <br /> Date of Age Entry Of Years Years <br /> Birth on Date Absence of Accrued of Accrued <br /> Name mm-dd-yy 12/31/04 mm-dd-yy (months) Service Liability Service Liability <br /> 26 <br /> 27 <br /> 28 <br /> 29 <br /> 30 <br /> 31 <br /> 32 <br /> 33 <br /> 34 <br /> 35 <br /> 36 <br /> 37 <br /> 38 <br /> 39 <br /> 40 <br /> 41 <br /> 42 <br /> 43 <br /> 44 <br /> 45 <br /> 46 <br /> 47 <br /> 48 <br /> 49 <br /> 50 <br /> 51 <br /> 52 <br /> 53 <br /> 54 <br /> 55 <br /> Subtotal of Page I Liability-Active Members Continued <br />