Fire Department Officer Form

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Fire Department Officer Form Printable pdf

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Return To:

Oswego County Fire Coordinator, 720 East Seneca Street, Oswego, New York 13126

Business #: 349-8800

Fax #: 349-8810

E-mail:

FIRE DEPARTMENT OFFICER FORM

NAME OF DEPARTMENT: _________________________________________________________

MAILING ADDRESS: ______________________________________________________________

FILING DATE:_______________________

EFFECTIVE DATE: ______________________

THE FOLLOWING IS A LIST OF LINE AND DUTY OFFICERS ELECTED TO OFFICE ON

(Month)________________ (Day)_________ (Year)___________ AT THE ANNUAL MEETING

PLEASE LIST FULL NAME, INCLUDING MIDDLE INITIAL AS IT APPEARS ON YOUR DRIVERS LICENSE

(NO NICKNAMES OR SHORTENED VERSIONS)

( First

M.I.

Last)

CHIEF: _________________________________ SOCIAL SECURITY #:_____________________

E-MAIL: _______________________________________________ TEL. #: ____________________

MAILING ADDRESS:_______________________________________________________________

ST

1

ASST: _______________________________ SOCIAL SECURITY #:_____________________

E-MAIL: _______________________________________________ TEL. #: ____________________

MAILING ADDRESS:_______________________________________________________________

ND

2

ASST: _______________________________ SOCIAL SECURITY #:_____________________

E-MAIL: _______________________________________________ TEL. #: ____________________

MAILING ADDRESS:_______________________________________________________________

RD

3

ASST: _______________________________ SOCIAL SECURITY #:_____________________

E-MAIL: _______________________________________________ TEL. #: ____________________

MAILING ADDRESS:_______________________________________________________________

TH

4

ASST: _______________________________ SOCIAL SECURITY #:_____________________

E-MAIL: _______________________________________________ TEL. #: ____________________

MAILING ADDRESS:_______________________________________________________________

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