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P 2 7 <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 />Juvenile Crime Prevention Council <br />_ Fire Advisory Board <br />Board of Health <br />Mental Health Board <br />NAME: L, <br />MAILING ADDRESS: <br />HOME PHONE: <br />YEARS LIVING IN <br />LEE COUNTY: <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 />Industrial Facilities & Pollution Control <br />Financing Authority <br />Rest Home -Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) M0VA_ f 4w*(� <br />WORK PHONE: (3310 3P`f' (o. 7a E-MAIL %ate r r'c�S�vi.rt�� j�� Cin lav c <br />DISTRICT YOU LIVE IN: <br />MALE: _ FEMALE: _iGVHITE: vl� BLACK: _ HISPANIC: _ NATIVE AMERICAN _ OTHER <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: 5"i Its <br />OCCUPATION: C,� re C. reQ-+`►•�ct%a,�- � �.� �,`,t — <br />OTHER 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 THRE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: 2 <br />1. t�.T � /:(/lel h� � 1 S �/1 � n � n - � 1, 7 ? l C <br />2 <br />3. <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />NOV — 3 2015, � <br />