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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 - 7184623. 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 />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 />NAME: DI A/II/Y� �� li✓� <br />MAILING ADDRESS: JZ1 Ri OGe RD, ►r4A"" F6 1 R1J 'N. C. .2 17a%?2 <br />HOME PHONE: q 1 q. 7 3 lid WORK' 770' S76S' E -MAIL 7 l'rM /)ajt t. com <br />YEARS LIVING IN <br />LEE COUNTY: / DISTRICT YOU LIVE IN: <br />MALE: _FEMALE: WHITE: BLACK: _ HISPANIC: NATIVE AMERICAN OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: �'. _ �,_; <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 time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />I. Iff; i 6-7_2r3' 3a - .2 <br />2. _)'Y)v Ph le IJai <br />3. <br />RE) <br />(Attach additional p ge if more pace is needed) <br />SIGNATURE: _ b Otw DATE: <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 2019 <br />/� 1 <br />