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I . t � 7 <br />V V 'Z <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: , M ; KE R � Oe I+0LA/Z <br />MAILINP DRESS: P O $ 0 X 7�L *,I* .APP% �t/L.S� _ r4.( 2733.2 <br />HOME VH&E: — Q 2. f 1 WORK PHONE: E -MAIL fAo' #0 tAle <br />YEARS LIVING IN G (� % CLOGtD. er-^ <br />LEE COUNTY: �o ! DISTRICT YOU LIVE IN: 67- rc - eocd V <br />MALE: FEMALE: _ WHITE: / BLACK: _ HISPANIC: NATIVE AMERICAN _ OTHER <br />1 <br />(information for the purpose of assuring a cross section of the community) <br />EMPLOYER: �E + �Q.Ed <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. -Fill 2rA M ? 02 - 9 3.E .� <br />2. t /tr6 l4AY�4 L 776 / 3z 1 <br />3. L. I'1! 1,S D jetaj <br />REASON(S) YOU WISH TO <br />si <br />(Attach additional pa f�,m_ore� ace ' eede <br />SIGNATURE: �� l "'(add 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 1 4 2014 <br />