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028 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDSUCOIAMISSIONS <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 Drve), 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 :'WD 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 />_ Parks & Recreation Commission <br />Board of Adjustments (Lee County) <br />— Planning Board (Lee County) <br />_ Board of Adjustments (Sanford) <br />_ Planning Board (Sanford) <br />Board of Equalization & Review <br />— Senior Services Advisory Board <br />— Cemetery Board of Trustees <br />Social Services Board <br />CCCC Board of Trustees <br />_ <br />— transportation Advisory Board (COLTS) <br />Juvenile Crime Prevention Council <br />_ Industrial Facilities 8. Pollution Control <br />Fire Advisory Board <br />Board <br />Financing Authority <br />of Health <br />X Rest Horne -Nursing Home Advisory Board (cannot have <br />Mental Health Board <br />a rEflative residing in a facility) <br />NAME: TF^ A/ Zy W,L/ E -- --- 2 7 2 <br />MAILING ADDRESS: 2.//40 sW414 7�R.4__" <br />HOME PHONE: I V C3 qq WORK PHOI�IE fo�� to E-MAIL <br />YEARS LIVING IN <br />LEE COUNTY: DISTRICT YOU LIVE IN: _ <br />MALE: — FEMALE WHITE:BLACK: _ HISPANIC: _— NATIVE AMERICAN _OTHER <br />QInformation for the purpose of assur ng a cross section of the community) <br />EMPLOYER: <br />OCCUPATION: <br />OTHER MUNICIPAL OR COUNTY BOARDS/COMMITTEES ONWHICH YOU ARE SERVING: <br />(Generally, the Board of Commissioners desires to broaden participation on Boards/Commissions for as much crit !en 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 related to anyone currently serving on any County board/commission? If yes, please state name and board they serve on <br />PLEASE LIST THR E (3) LO L PERSONAL REFERENCES AND PHONE NUMBERS: <br />/1 1-10071 <br />LEASO S) YOU WISH TO fiSERVE � N�r�GG� _) GLJ, �C©�f� �I=_LL�,r.✓./ <br />Attach additional <br />( p ge i more space ' de <br />SIGNATURE: — <br />NOTE: ALL ES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENIT �1 r � X04 <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD 11'31 <br />"1-7 <br />