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047 <br />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 />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 Horne -Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />NAME: P a L FD K n is, F-®� L <br />MAILING ADDRESS: _ z op-, o� /��� <br />HOME PHONE: cj/% - �zf:5� WORK PHONE:A,///? E-MAIL /2'2 <br />YEARS LIVING IN <br />LEE COUNTY: 70 DISTRICT YOU LIVE IN: Gr <br />MALE: ✓FEMALE: —WHITE: ,-BLACK-.— HISPANIC: _ NATIVE AMERICAN _ OTHER <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: <br />OCCUPATION: 2 r i^2 D <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 />Are you ralated to anyone currentiyVati•i 9 ori any Cuun:y boardicotnrnist ioi;? :,yes, please state naive acid board Lhey serve on <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. �� ce 73r,.,,L0 [�Y �I 9 - r29 6o - Co r% S� <br />2. //,fire CR0Cc ?k, GJ19- �7S - <br />3. ,ALL W/---J7- <br />REASON(S) <br />JTREASONS) YOU WISH TO SERVE <br />(Attach additional page if M? re space i <br />SIGNATURE: / <br />DATE: 1_7'-t,�z_ -Zig <br />NOTE: ALL TAXES MU,5T BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />,net <br />