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(i3 <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 CO MMISSIONS <br />Sanford -Lee County Airport Authority <br />_ Jury Commission <br />Agriculture Advisory Board <br />_ Library Board of Trustees <br />_ Americans with Disabilities Act (ADA) <br />_ Parks & Recreation Commission <br />_ Board of Adjustments (Lee County) <br />_ Planning Board (Lee County) <br />Board of Adjustments (Sanford) <br />_ Planning Board (Sanford) <br />_ Board of Equalization & Review <br />_ Senior Services Advisory Board <br />Cemetery Board of Trustees <br />_ Social Services Board <br />_ CCCC Board of Trustees <br />_ Transportation Advisory Board (COLTS) <br />_ Economic Development Corp. <br />Juvenile Crime Prevention Council <br />Fire Advisory Board <br />_ Industrial Facilities & Pollution Control <br />_ Board of Health <br />Financing Authority <br />Mental Health Board <br />_ Rest Home - Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />NAME: J-LlA N D !1 - W AN C Q <br />MAILING ADDRESS: '2&02 NI A L CAVE Q-b . <br />HOME PHONE roir -mri, WORK PHONE 11)11f' V0 E -MAIL obV 1I COW% <br />YEARS LIVING I <br />LEE COUNTY: q MOs DISTRICT YOU LIVE IN: <br />MALE: )L FEMALE: _ WHITE: _ BLACK: _ HISPANIC:)(_ NATIVE AMERICAN _ OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: L-M C ouNTy 1a EAL TtA n(t <br />OCCUPATION: PRpGC,4S1NJ. Q V MP T)l 12EGls - X - VZ^ a <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />non <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. >Eb&AIZ T. MtNpotA (91o) 5"9 6 I <br />2. lqt F-C ,f 112 A 651 41 Y I el D 6 <br />3. RICA AE)b A VIL Cilot 21f- bqX 7 <br />REASON(S) YOU WISH TO SERVE Wa91VT Tn R t pg I? d p T #F S DL VT( arr 4 - a <br />t - p TH y ov- AA W Nb WILL Slot P t '1"!r{ rrtfTif (t E <br />(Attach additional page ' re p <br />SIGNATURE: _— DATE: Q �� <br />NOTE: ALL TAXt°"UST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />007 - 2201 <br />✓: <br />