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i1 v i� <br />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 />_ 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: 4J!A0e40h M A C&AM 1 C <br />MAILING AD RESS: 2 'rVe�;P "/,I Txew at. ,e146Gd.¢O_ <br />HOME 16Z Y 99 - * _ = WORK PHONE: E -MAIL <br />YEARS LIVING IN 4/ /�i1i�fF/��• S�; <br />LEE COUNTY: t DISTRICT YOU LIVE IN: S r <br />MALE: _ FEMALE:1/WHITE: LACK: _ HISPANIC: _ NATIVE Am OTHER _ <br />I (kformatlon for the pygtoge 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 />1. :0! ;& TF'9 rX.F / - !P/!?- 3 a.2 -- 933 <br />3. <br />EASON(S) YOU ISH TO RVE <br />s <br />(Attach addifiona p ge if more Wis eeded) S . ---- SIGNATUR DAT a <br />NOTE: ALL TAXES MUST BE Pwb IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD -kll:) � Z <br />JUL 1 5 1A0 <br />I � <br />