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COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDS/ /COMMISSIONS <br />If you we a Lee County citizen icti mmded in serving as a n►eniber of one of the CounWs Advieoxy Boards, Please <br />complete the form below and mail to Cleric 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 />_ Sanford­Lee County Airport Authority <br />Agriculture Advisory Board <br />Americans with Disabilities Act (ADA) <br />_ Board of Acqudments (Lee County) <br />— Board of Adjtt * rtts (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 />NAME: <br />MAILING <br />HOME PI <br />YEARS LIVING IN <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 />_ <br />Juvenile Crime Prevention Council <br />industrial Facilities & Pollution Control <br />Financing Authority <br />_ Rest Hone-Nursing Horne Advisory Board (cannot have <br />a relative residing in a facility) <br />n _ <br />LEE COUNTY DISTRICT YOU LIVE IN: <br />MALE.V FEMALE: — WHITE: BLACHISPANIC: NATIVE AMERICAN OTHER <br />JA { IMormation for purpose of assurkrg as crass section of the cor nimmity) <br />EMPLOYER: Sti <br />OCCUPATION: <br />OTHER MUNICIPAL OR COUNTY BOARDS/COMMITTEES ON WHICH YOU ARE SERVING: <br />(Generally. the Board of Co"wiftsioners dashes to broaden parbdpabon an BoardsiCAmmissions for as much alfren Wr4ohrernent <br />as possible; ftrdwe Per Board porky, appoinheas can serve on no more ttran two (2) Board&rAwnffdssxm at a time. <br />PLEAVLIST THREE (3) LOCAL P1 <br />2. r �1 <br />3. -fkC (tl It P <br />REASON(S) YOU'WISH TO SERVE <br />w _ > > . <br />o_.V. <br />AND <br />(Attach addtional if more space is nt � U <br />SIGNATURE: b()1.�Q, DATE: /1� IN <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />oo. u <br />SEP 2 9 2014 <br />