Fire State Aid Certification (Form FA-1)

for Fire State Aid Payable in 2026

To avoid penalty, electronically submit this form by March 15, 2026

County

Fire Department Name

Fire Department ID (Assigned by the State Fire Marshal)

Public-Safety Answering Point (PSAP) and Dispatch Agency

Fire Service Area Report as of Dec 31, 2025

Percentages that are less than 100% are those agreed on by all fire departments that provide protection to the indicated municipality by completing an apportionment agreement. The percentages are based on population and estimated market value, not land area.

City/Town Code	Service Area*	% Served

* If your service area includes any unorganized areas, the percentage shown is based on information we have received from the county to apportion those areas between fire departments.

Certification of Service Area

Choose one of the statements below after reviewing the Fire Service Areas Report shown above.

If changes were made to the service area of your department by Dec. 31, 2025, please clearly indicate that when submitting this form by providing any applicable fire protection contracts, termination notices, and apportionment agreements as attachments. Information about apportionment agreements and a blank apportionment agreement form can be found in the instructions. No changes will be made for Fire State Aid purposes without sufficient documentation.

The Fire Service Area Report above for my department is accurate as of December 31, 2025.

The Fire Service Area Report above is not accurate as of December 31, 2025. The supporting documentation providing evidence of the necessary change, as described in the above, is included as an attachment with this certification.

Attachments

Certification of Fire Department Status

I certify that the fire department has provided service for at least one calendar year prior to December 31, 2025.

Certification

Form FA-1 must be certified by the person authorized by statute; refer to the instructions for more information.

I certify that I am authorized to submit this information and that it is true and correct to the best of my knowledge. I understand that anyone giving false information is subject to a fine of up to $3,000 and/or up to one year in prison. [Minnesota Statutes, section 609.43]

Certifier Name

Certifier Title (Secretary/Municipal Clerk)

Certifier Phone Number

Certifier Email