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045 <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 mai to Clerk to the Board, (408 Summit Drive), PO Box 1968, Sanford, NC, 27331- <br />1968 or fax to 919-7184623. 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 Disabiities Act (ADA) <br />Board of Adjustments (Lee County) <br />X 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: Wiliam J. Oberkirsch <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 S Pollution Control <br />Financing Authority <br />Rest Home -Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />MAILING ADDRESS: 1101 Stoney Brook Dr. Sanford NC 27330 <br />HOME PHONE: 919-774-3265 WORK PHONE: E-MAIL Bill.Ob rkirsch9bcharter.net <br />YEARS LIVING IN LEE COUNTY: 11 DISTRICT YOU LIVE IN: 4. <br />MALE: X FEMALE: _ WHITE: X BLACK: HISPANIC: _ NATIVE AMERICAN , OTHER <br />(Infonnedon for the purpose of assuring a cross section of the co munily) <br />EMPLOYERS Praomatics. LLC <br />OCCUPATION: Application Developer <br />OTHER MUNICIPAL OR COUNTY BOARDS/COMMITTEES ON WHICfi YOU ARE SERVING: <br />1) Leery Parks and Recreation <br />(Generally, the Board of ConrrOssioners desires to broaden pard ipatbn on BoardsCAwrrnisslons for as much cktmn involvement <br />as possible; Urerefore per Board policy, appointees can serve on no more than two (2) Boards/Comnrisstons at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />I. Joe and Denise Hawksbv 919-775-2184 <br />2. Shannon Gurwitch 931-237-2924 <br />3. Brenda Kelly 919-770- 6862 <br />REASON(S) YOU WISH TO SERVE I want to be more involved in the community <br />(Attach additional page If more space is neeAsM <br />SIGNATURE: e DATE: <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />DEC 2 { 20151 <br />i <br />