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VI /G1 /LV1'! 1J: G4 rAA <br />[a 001 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDS/ /COMMISSIONS <br />If you are a Lae County citizen interested in serving as a member of one of the County's Advisory Boards, please <br />complete the form below and MON bo Clerk to die Board, (408 Summit Drive), PO Box 1968, Sanford, NC, 27331. <br />1968 or fax to 919.7184623. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />- Sanford-Lee _ Agriculture Advisory County Board Airport Authonty <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: S U- Z Cx h h e . . <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 />relative residing in a fadNty) <br />C MAILING ADDRESS; 7 F` C. Ufa 4 r, <br />-M6tRE PHONE: ��0/- Iv�S- j 5WO WORK PHONE: _ VIA E -MAIL ?0 " <br />YEARS LIVING IN. <br />LEE COUNTY. DISTRICT YOU LIVE IN: <br />MALE: FEMALE: WHITE: _ BLACK HISPANIC:,, NATIVE AMERICAN _ OTHER <br />EMPLOYER: //I/� _ <br />(InrbmWon for tlo pufP� of aeeurHp r cross sewon of a* commurMlY) <br />OCCUPATION: t i 6d <br />OTHER MUNICIPAL OR COUNTY BOAROS/COMMITTEES ON WHICH YOU ARE SERVING: <br />_ No/y <br />as pos sly the board of r SOM POL deem to broaden panicowon on ecardscmwir dons for as much dUtsn involvement <br />se posalbla; tlwefore per board PAY, <br />appointees een eorve on no more than lwo ) 6oaroa/ <br />PLEASE LIST THREE (3) LOCAL PER ONAL REFERENCES ANDP ONE NUMBERS: time, <br />1. - 9 8 U)'► l 'l �.m 'Y1 c '► <br />2. 1Ll n - �r <br />SON(S) YOU WISH TO SERVE +b y� <br />r „'1 <br />(Attach additional p if nw �� i')1 h i � I O n ' n ,'`� <br />apace le "' ,, <br />SIGNATURE: I � DATE: oZ a l) <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />n t',c� �, -gyp � o ` I ���D 0.. ►'1 V i S; �� J h o m C <br />so :r �� h 0 U 1 Ci- S tc <br />wP n 0U) . <br />JUL 2) 20x4 <br />