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(" '? , <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, 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 />NAME: Lrl <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 />->s, 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 />MAILING ADDRESS: rady__Gr-e t- DV-, <br />HOME PHONE: WORK PHONE: (1 19 - ) - 3-c, - -MAIL <br />YEARS LIVING IN <br />LEE COUNTY: <br />DISTRICT YOU LIVE IN: <br />MALE: — FEMALE: — WHITE: _ BLACK: _ HISPANIC: ,k NATIVE AMERICAN OTHER <br />(Information for the purpose of assurina a cross section of tha rnmmi i�itvl <br />EMPLOYER: <br />OCCUPATION <br />U I NhK 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. NO',A lN%V_ t r- fl,C /aq <br />2. <br />REASON(S) YOU WISH TO SERVE - - 1 - - <br />If )•t 'c� w v ► t <br />(Attach additional age More spa is n ded) <br />SIGNATURE: DATE: 6 <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />AUG 1 1 2014 <br />