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U 3 <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, Sapfbrd, 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 />— 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: "Wiaey G o ADo' <br />MAI l N g G ADDRESS: $' X 90 A" R ll ✓� R�• .Si9 ,[ Q N,� '73.: <br />HOMEPHONE: 6,01 WORK PHONE: AI I,SC•O TTS sA 'o x Y ygf/ <br />YEARS LIVING IN © 000-0 <br />Y <br />LEE COUNTY: // c– 'STRICT YOU LIVE IN: D8ze <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 brow <br />as possible; therefore per Board policy, appointees can <br />;Ipanon on boartlS/Commissions for as much citizen 1 <br />no more than two (2) Boards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. 16 1 1 7,12ZK 9Y 9 -30.2 -- 7 3 2 <br />3. /�, <br />REASONS) YOU WISH TO SERVE =g- ! I/ a., 'C &7 <br />6:�r <br />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 16 2%� <br />