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r <br />1 v <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, <br />please complete the form below and mail to Clerk to the Board, Lee County Government Center, PO Box 1968, <br />Sanford, NC, 27331-1968 or fax to 718-4631. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <br />Sanford-Lee County Airport Authority - <br />Jury Commission <br />Agriculture Advisory Board _ <br />Library Board of Trustees <br />- Americans with Disabilities Act (ADA) _ <br />Mid-Carolina workforce Development Board <br />Board of Adjustments (Lee County) _ <br />Parks & Recreation Commission <br />_ Board of Adjustments (Sanford) <br />Planning Board (Lee County) <br />_ Board of Equalization & Review <br />Planning Board (Sanford) <br />_ Cemetery Board of Trustees _ <br />Rest Home-Nursing Home Advisory Board <br />- CCCC Board of Trustees _ <br />Senior Services Advisory Board <br />Economic Development Corp. _ <br />Social Services Board <br />Fire Advisory Board <br />~ <br />Transportation Advisory Board <br />p <br />Environmental Affairs Board X <br />Juvenile Crime Prevention Council <br />Board of Health <br />Criminal Justice Partnership Advisory Board <br />Industrial Facilities & Pollution Control Financing Auth. <br />NAME: tt. E&rF ~V'~2E7'T <br />MAILING ADDRESS: F O. X -7 1,:j <br />Srq y1 ~'DjL17 Ill G a "I -3i 3 <br />HOME PHONE: (q U 5- 4756 WORK PHONE: &r0_7 19 - 4567 E-MAIL Kayl0-9 a-stP,,e,,>n17t>c <br />• YEARS LIVING IN <br />LEE COUNTY: 14 - DISTRICT YOU LIVE IN: <br />MALE: XFEMALE: _WHITE: BLACK HISPANIC: NATIVE AMERICAN OTHER_ <br />(Information for a purpose of assuring across swlon of the community) <br />EMPLOYER: Lee, NTteaol T i(_ <br />OCCUPATION: GIn(.]~ 'TA., "'p, <br />OTHER MUNICIPAL OR COUNTY BOARDS/COMMITTEES ON WHICH YOU ARE SERVING: Y sL-J19 <br />(Generally, the Board of Commissioners desires to broaden PerticipsUon on Boards/Commissions for as much citizen Involvement <br />as possible; therefore per Board policy, appolntaos can some on no more the two (2) Boards/Commisslons at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. W~llVP,-O-, K`xg~lllrS Gto-(055-4295 <br />^ <br />3. YY1a.L"t3. IAC~'C ttl tMV+nsv» olq- 4'l s^ - Onn& <br />SIGNATURE: A'4 a DATE: 3 - ;ZC1 ~ 114 <br />Cl <br />200 d 9E 91 (03M)4002-l2-170 <br />