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U 8 <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, (408 Summit Drive), PO Box 1968, Sanford, NC, 27331- <br />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 />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 />Financing Authority <br />Rest Home - Nursing Home Advisory Board (cannot have <br />� ��`.� a relative residing in a facility) <br />MAILING ADDRESS: v 1 4 chi <br />HOME PHONE: — WORK PHONE: 5 - 2M E -MAIL V haD �r>V. <br />YEARS LIVING IN <br />LEE COUNTY: 1 DISTRICT YOU LIVE IN: JJ5.}- <br />MALE: _ FEMALE: ✓GVHITE: _ BLACK: o/HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: 0 1e,1 (- <br />OCCUPATION: Ba S', SAS 6611 4141 4 <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 time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />- // 9- -7 zl4 a <br />2. Me,&- e 40 S4, - to <br />V <br />/ 1P - 3 S':�- v <br />REASON(S) YOU WISH TO SERVE l kavc = <br />(Attach additipnal page if more spade is eeded) S h&xv 4- CPr,' ,� o ;,,,tom <br />SIGNATUR r/ DATE: �f-4, �2p/ y IA 'S "' I os�(; Vrt <br />e- Spic; <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />MAY — 6 20 <br />