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COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDSHCOMMISSIONS <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 />X 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 />_ 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 rela <br />'' ++ tive residing in a facility) <br />NAME: 'Rooa d P 101e <br />01 e ' <br />MAILING ADDRESS: AqF C-0 'ferl Gal ofitzrri. Lt A733 c <br />HOME PHONE:RJg " -(P&g3 WORK PHONE:g19- 857 - 1 1%31 E -MAIL tuna 1d, t. , 11e# tX Q9r " 90V <br />YEARS LIVING IN <br />LEE COUNTY: S DISTRICT YOU LIVE IN: W e4 6.. 'kao - �Jw ✓+ <br />MALE: FEMALE: _ WHITE: V BLACK: _ HISPANIC: _ NATIVE AMERICAN OTHER _ <br />pp (Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: N CpA b CS <br />OCCUPATION: State Chemist & La6o1ra4yrW Tech cal Dir k <br />OTHER MUNICIPAL OR COUNTY <br />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 />1. 1P aw. K 9 1 - ) 7 47 � 7 A R <br />2. <br />3. J 4 V i a CkU,[A w i I ( q 7 7 6 9 5 / tD <br />REASON(S) YOU WISH TO SERVE {' e ern a4lCk Z k, ,4, <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />JUL 2 1 2014 <br />ii <br />