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008 <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 />x 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 ina facility) <br />NAME: _�-�►GIL �at�'�A,Q <br />MAILING ADDRESS: 2240S <br />HOME PHONE: WORK PHONE: (qla) ?iSd –b6� �E-MAIL <br />YEARS LIVING IN J <br />LEE COUNTY: 13 DISTRICT YOU LIVE IN: <br />MALE: — FEMALE: _ WHITE: _ BLACK:_ HISPANIC;X NATIVE AMERICAN _ OTHER <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: <br />OCCUPATION <br />U t HER 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 />3. 16Y1L 5K-}►\(a0060%3s-31g7 <br />REASON(S) YOU WISH TO SERVE Z W d 4 A,,, L o 1 n <br />(Attach additional nage if more <br />SIGNATURE: <br />DATE: <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />AUG i � z <br />