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ANNUAL FIRE DEPARTMENT REPORT MATT M. ROSENDALE Commissioner (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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MATT M. ROSENDALE
Commissioner of Insurance &
Securities
Office of the State Auditor
840 Helena Avenue
Helena, Montana 59601 (406)
444-2040
ANNUAL
FIRE
DEPARTMENT
REPORT
File on or before April 1
st
_______________________________________, Montana __________________________, 20____
(City or Town)
Pursuant to the provisions of Section 19-18-511, MCA, I respectfully submit the following report on the
_______________________ Fire Department for the preceding year ending December 31, .
Date Organized:____________Number of Stations: _____Business Phone Number:______________
Number of: Engines________ Trucks________ Other:________ Specify_______________________
Does the value of all equipment exceed $750.00? Yes__________ No__________
Volunteer Fire Departments Only (complete the following two questions):
1. Time & Location of meetings________________________________________________
2. Have all members received at least 30 hours of instruction during the past year?_______
Number of active members: Paid__________ Part Paid__________Volunteer__________
Number of Civilian Employees: Paid__________ Part Paid__________Volunteer__________
Chief________________________________________________Home Phone___________________
Asst. Chief___________________________________________ Home Phone___________________
Fire Marshall_________________________________________ Home Phone___________________
Water Supply:
Source of Supply_____________________________________Storage Capacity______________Gal.
Miles of Mains_____________Number of Hydrants_____________Average Pressure_____________
Hydrants maintained and flushed by____________________________________________________
Describe Fire Alarm System: __________________________________________________________
(OVER)
Apparatus-Pumping
Year
Make
Pumping
Cap. GPM
Tank
Capacity
3” Hose
Carried (ft.)
2 ½’ Hose
Carried (ft.)
1 ½” Hose
Carried (ft.)
1. ______
2. ______
3. ______
4. ______
5. ______
__________
__________
__________
__________
__________
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
___________
___________
___________
___________
___________
__________
__________
__________
__________
__________
__________
__________
__________
__________
__________
Apparatus-Aerial or Elevating Platform
Year
Extended Height
Equipment With Pump
1. _______
2. _______
Apparatus-Other
Year
Make
Use of Equipment Carried
1. _______
2. _______
Hose
Size
Total
Feet
N.S.
I.P.T.
Other
Tested Annually?
Yes No
Pressure
3”
2 ½”
1 ½”
I hereby certify the above information is true and correct to the best of my knowledge.
____________________________________ ___________________________________
(Signature of City Clerk) (Type or Print Name of City Clerk)
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ANNUAL FIRE DEPARTMENT REPORT MATT M. ROSENDALE Commissioner (Montana Office of the Commissioner of Securities and Insurance, Montana State Auditor)

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Completed 20 July 2020

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