Office of the State Fire Commissioner

OSFC-VL-4 (Revised 05/16)

Commonwealth of Pennsylvania OFFICE OF THE STATE FIRE COMMISSIONER Volunteer Loan Assistance Program 1310 Elmerton Avenue, Harrisburg, Pennsylvania 17110-9364 (717) 651-2200 or 800-670-3473

RECOMMENDED PUBLICATION FORM

The ______hereby announces its (Charter Name of Company) intention to apply for a loan from the Volunteer Loan Assistance Program administered by the Office of the State Fire Commissioner. The ______(Company) hereby certifies that: 1. The ______by-laws do not discriminate (Company) against applicants for membership on the basis of race, color, religious creed, national origin, sex, age or handicap; and 2. There is not an unwritten policy of discrimination for membership in the ______

______. (Company) Comments on this application should be forwarded to ______(Company Address) ______and the Office of the State Fire Commissioner, Volunteer Loan Assistance Program, 1310 Elmerton Avenue, Harrisburg, PA 17110.

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THERE IS A 30-DAY PUBLICATION PERIOD IMMEDIATELY PRIOR TO APPLYING FOR THE LOAN. It is recommended the advertisement be done a week or two before the loan application is submitted to us. The VLAP staff will compare the actual PUBLICATION DATE with the recorded RECEIPT DATE of your company's forms to determine if the 30-day criteria has been met. The receipt date is the date the application is received in this office.

1. Complete the above sample form, OSFC-VL-4. Send or take it to a newspaper of general circulation published regularly in your service area. Arrange for a one-day advertisement at your company's expense. Make sure the invoice is sent to your company and NOT to this office. 2. Request a "Proof of Publication of Legal Notice," which newspapers must provide under the provisions of the "Newspaper Advertising Act" (Act 587, approved May 16, 1929). That standard and notarized document, familiar to all newspapers, must contain the ORIGINAL newspaper article of your newspaper advertisement. If your newspaper cannot provide the required document, find the nearest one that will.

3. Submit the Proof of Publication Legal Notice to this office with your initial forms within 30 days of the date the advertisement appears in the newspaper. The original notarized Proof of Publication form that includes the original newspaper advertisement must be returned. Copies are not accepted and will delay the processing of you loan application. The above sample VL 4 does not need to be returned with your forms.