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<br />Office of the Fire Fighters' Pension Commissioner <br />TEXAS EMERGENCY SERVICES RETIREMENT SYSTEM <br />P.O. BOX 12577 AUSTIN, TX 78711-2577 (800) 919-3372 FAX (512) 936-3480 <br />WWW.FFPC.STATE.TXUS/FFPCONLlNE.HTML <br /> <br />LA PORTE FIRE DEPARTMENT <br /> <br />MEMBERSHIP RECONCILIATION REPORT FOR THE QUARTER ENDING May 31,2010 <br /> <br />May 03,2010 <br />Page 1 of 4 <br /> <br />LA PORTE FIRE DEPARTMENT <br />ATTN: PAT MC CABE, CHAIRMAN <br /> <br />TO ADD OR TERMINATE MEMBERS, <br />VISIT WWW.FFPC.STATE.TX.US AND <br />LOGON TO FFPC ON-LINE <br /> <br />THIS IS NOT A BILL <br /> <br />Instructions <br /> <br />To facilitate the collection of member contributions, the chairman of the local board of trustees of each participating <br />department, before 10 days of the last day of the quarter, shall file with the Commissioner a certified membership <br />roster that states the name of each member of the department who is a member of the retirement system. The certified <br />roster may be faxed to the Commissioner at (512) 475-2430. <br /> <br />The pension roster report will fully disclose the basis for the quarterly billing. The following pension roster states the <br />name of each member of the department who is a member of the retirement system. The chairman of the local board of <br />trustees or department head shall review the accuracy of the pension roster report. To add or terminate members <br />incorrectly identified in the pension roster report, departments should add or terminate members using the pension <br />system website (www.ffpc.state.tx.us/ffpconline.html). If no changes are made, the following roster will be the basis for <br />the quarterly billing. <br /> <br />Certification by Local Board Chair <br /> <br />As Chair of the Local Board of Trustees for the department identified above, I certify that I have reviewed the pension <br />roster report of active members and that I have determined that it reflects the membership of my department that is <br />participating in the pension system. I understand that any participating member of my department that is not on this <br />pension roster report is not eligible to receive any pension, disability or death benefits provided for by the pension <br />system. <br /> <br />~Uv <br /> <br />PAT MC CABE, CHAIRMAN <br /> <br />s .~- "2L>to <br /> <br />Signature Date <br /> <br />VER: 2008.08.001 <br />