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013 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDS/ /COMMISSIONS <br />If you are a Lee County citizen interested in serving as a member of one of the County's Advisory Boards, please <br />complete the form below and mail to Clerk to the Board, Lee County Government Center, PO Box 1968, Sanford, <br />NC, 27331 -1968 or fax to 919 - 718 -4623. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <br />_ Sanford -Lee County Airport Authority <br />_ Agriculture Advisory Board <br />_ Americans with Disabilities Act (ADA) <br />— Board of Adjustments (Lee County) <br />_ Board of Adjustments (Sanford) <br />_ Board of Equalization & Review <br />_ Cemetery Board of Trustees <br />_ CCCC Board of Trustees <br />— Economic Development Corp. <br />_ Fire Advisory Board <br />_ Board of Health <br />_ Mental Health Board <br />NAME: <br />MAILIN( <br />HOME PHONE: <br />YEARS LIVING IN <br />LEE COUNTY: <br />MALE: _ FEMALE: I"WHITE <br />EMPLOYER: <br />Jury Commission <br />_ Library Board of Trustees <br />_ Parks & Recreation Commission <br />— Planning Board (Lee County) <br />_ Planning Board (Sanford) <br />Senior Services Advisory Board <br />_ Social Services Board <br />_ Transportation Advisory Board (COLTS) <br />_ Juvenile Crime Prevention Council <br />Industrial Facilities & Pollution Control <br />_Y Financing Authority <br />*est Home - Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />W C � / PHONE: TO - 1 7 1 1 - IQA E -MAIL N I n % e r= tV, live. t oln <br />DISTRICT YOU LIVE IN: <br />BLACK: _ HISPANIC: — NATIVE AMERICAN — OTHER <br />(Information for the purpose of assuring a cross section of the community) <br />OCCUPATION: <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />(Generally, the Board of Commissioners desires to broaden participation on Boards/Commissions for as much citizen involvement <br />as possible; therefore per Board policy, appointees can serve on no more than two (2) Boards/Commissions at a tine. <br />ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />NOV 202013 <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. B% W&Tf'3. /o. - Pffew %t aK1E l/V. j AA!!FjAW, T4.0 9lg•3az -9 <br />