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Apr 0214 08;02a Tramway Elementary School <br />9197741325 p.2 <br />0 �a 0 <br />If you are a Lee Couni. <br />complete the form belt <br />1968 or fax to 919 -718 <br />_ Sanford -Lee Cour <br />_ Agriculture Advise <br />Americans with Di <br />_ Board of Adjustmi <br />— Board of Adjustmi <br />Board of Equalize <br />— Cemetery Board i; <br />CCCC Board of T <br />_ Economic Develo <br />_ Fire Advisory Boa <br />Board of Health <br />_ Mental Health Boi <br />NAME: r `'1 Y I <br />MAILING ADDRESS: <br />HOME PHONE: 4 1 <br />YEARS LIVING IN <br />LEE COUNTY: I t <br />MALE: _ FEMALE: J <br />EMPLOYER: —Tr" <br />OCCUPATION: <br />OTHER MUNICIPAL <br />(Generally, the Board of C <br />as possible; therefore per <br />PLEASE LIST THRE <br />1. And r-- <br />2. _DW't <br />REASON(S) YOU <br />(Attach additional p <br />SIGNATURE: <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDS/ /COMMISSIONS <br />r citizen interested in serving as a member of one of the County's Advisory Boards, please <br />N and mail to Clerk to the Board, (408 Summit Drive), PO Box 1968, Sanford, NC, 27331 - <br />t623. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <br />f Airport Authority <br />_ Jury Commission <br />ir Board <br />_ Library Board of Trustees <br />abilities Act (ADA) <br />_ Parks $ Recreation Commission <br />its (Lee County) <br />_ Planning Board (Lee County) <br />its (Sanford) <br />_ Planning Board (Sanford) <br />)n S Review <br />_ Senior Services Advisory Board <br />Trustees <br />_ Social Services Board <br />Istees <br />Transportation Advisory Board (COLTS) <br />vent Corp. <br />_ <br />Juvenile Crime Prevention Council <br />_ Industrial Facilities & Pollution Control <br />Financing Authority <br />d <br />_ Rest Home - Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />ttt'12 Q: 14I1 <br />ll 60 <br />105 Moc.kk, 1, 0 Q1332- <br />IT "V WORK PHONE: C jR1IgC1 - 1 0 E -MAIL Ck he- 6k: aC -j -^ <br />Cc�r <br />J DISTRICT YOU LIVE IN: <br />WHITE: t/ BLACK: _ HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />Ci Iv-,w n- l e_ yr) e r1 + -nL r' S C h c o <br />,-, -.-, t,l,_c 'o }teal flee <br />COUNTY BOARDSICOMMITTEES ON WHICH YOU ARE SERVING: <br />stoners desires to broaden participation on BoardslCommissions for as much citizen involvement <br />policy, appointees can serve on no more than two (2) Beards/Commissions at a time. <br />LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />51 cCL r CA Ic1 -3 (r, - - 1 - 1L+I <br />\ en <br />=1 �011ffiL <br />i TO SERVE �L 5 I1�rE- <br />441c, , krtio %lefi54C � �e v� fro ire <br />i� 6_nn �yto o-Ae- _%4y -c en : �— v� : v". .� h. h <br />DATE: � 3 1 t <br />NOTE: ALL TAXES f' UST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />a,,.tS h t °s5� r `-� -II cur APR - 2 ZOl <br />G� Im m I &n i A-P.0 Y o 6 Qrc t- i <br />I S <br />I <br />