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015 <br />APPLICATION TO SERVE N BOARDS / /COMMISSIO <br />If you are a Lee County citizen interested in serving as a NS <br />complete the form 9 member of one of the County's Advisory Boards, please <br />belowand mail to Clerk to the Board, (408 Summit Drive), PO Box 1968 <br />1968 or fax to 919 - 718 -4623. YOU MUST BE A RESIDENT OF LEE COU <br />NTY TO APPLY Sanford, NC, 27331 - <br />BOA <br />RDS 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 T rus t ees <br />_ CCCC Board of Trustees <br />-_ Economic Development Corp. <br />Fire Advisory Board <br />_ Board of Health <br />Mental Health Board <br />NAME: _ Ib- <br />MAILING ADDRESS: <br />_ Jur 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 />HOME PHONE: z <br />YEARS LIVING IN WO RK PHONE: <br />E -MAIL __ <br />LEE COUNTY: <br />DISTRICT YOU LIVE IN: <br />MALE: — FEMALE: _ WHITE: _ <br />BLACK: HISPANIC: <br />(I NATIVE AMERICAN <br />nformation for the purpose of assuring a cross section of the community) OTHER <br />EMPLOYER: <br />OCCUPATION ~ <br />OTHER MUNICIPAL OR COUNTY BOA RDS /COMMITTEES ON W <br />HICH YOU ARE SERVING: <br />(Generally, the Board of Commissioners desires to broaden <br />par <br />as possible; therefore per Board t) n o o on B <br />mo for as much citizen involvement <br />policy, appointees can serve on no more than two (2) Bo ards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PH <br />I IC •NE NUMBERS: <br />2 <br />3. K-,k AIL <br />I -stau <br />REASON(S) YOU WISH TO SERVE <br />�b <br />(Attach additional age ' " ores ac is n <br />SIGNATURE AT i A <br />M <br />DATE: 6 <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONS IDERED FOR <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD A PPOINTMENT <br />L <br />�1 q 3 ,5 - - <br />AUG 1 1 2014�..' <br />