Laserfiche WebLink
022 <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 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 />Sanford -Lee Co. Partnership for Prosperity <br />Fire Advisory Board <br />_ Board of Health <br />Mental Health Board <br />NAME: <br />MAILING <br />il" 111 <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 in a facility) <br />am <br />HOME PHONE: 1 iq 77(,.W21 WORK PHONE: 1fi ,3foq Yq3! E-MAILroc'o—t— <br />MAI-Ele!!! <br />YEARS LIVING IN q opq �-kmeY � J <br />LEE COUNTY: DISTRICT YOU LIVE IN: _ %�c _S <br />FEMALE: _ WHITE: BLACK: ' HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />✓ n (lnforrpatjon for the purpose of assuring a cross section of the community) <br />EMPLOYER: <br />OCCUPATION: <br />o <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 />LIST THREE (3) LOCAL <br />arry nn r, <br />�A <br />3. 1ICA], L cx Vi 1A <br />REASON(S) YOU WISH TO SERVE <br />L REFERENCES AND PHONE NUMBERS: <br />U `71 C! Le,ne- Q I ' <br />-17 6 qQT- pre <br />,3t0SR,wq11'�r �* n <br />�WffisM <br />U l5` <br />;r"eS <br />'Sing bar <br />c ,i`Sed co <br />(Attach additional page if more space is needed) <br />M"y U�,5 --� <br />/ , <br />�ru���. -p�f �� ; ;;� DATE: 2 — I5 <br />SIGNATURE: <br />lel �6 <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />Fr - <br />DEC - 7 Z!!)� _ <br />J <br />