Laserfiche WebLink
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 />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 />I dustrial Facilities & Pollution Control <br />Financing Authority <br />Rest Home -Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />NAME: ,V:/i/C y 3—V HNs0_V <br />MAILING ADDRESS: ZD 3 eQQRY-C 77'44D�Py N, (�. .27 SVS - <br />HOME PHONE: (oD�:a 17*ORK PHONE: _ ^�c� E-MAIL %e OMA(�. CDM <br />YEARS LIVING IN �//��,, <br />LEE COUNTY: I& - ctrs'�/i�1$TRICT YOU LIVE IN: ? <br />MALE: _ FEMALE: WHITE: BLACK: _ HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />/� (Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: we ( .row � l u -e S h i el d b� �! (2_,� <br />OCCUPATION: <br />OTHER MUNICIPAL OR CO�,,U,NNTY BOARDSYLOMMITTEES ON WHICH YOU ARE SERVING. <br />ki a, �C% <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 related to anyone currently serving oo ai%county board/commission? If yes, please state name and board they serve on <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMRFRS <br />1 <br />2. <br />3. Lois <br />M121rm <br />REASON(S) YOU WISH TO SERVE �_ftJtV 8 <br />`J <br />61/'e r `�"1v 10i � 0 qe6c6,Q s <br />(Attach additional age if more p Ae ed) <br />- 7Sa <br />�n� q l o f o4F-1 nnta ✓I st <br />Pr r,eSi JcJ i A ren e . <br />a. r1UV,;r_< homes <br />SIGNATURE: DATE: % <br />NOTE: ALL TAXA MUST E 41D IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />� ke_ ►��� �-� cid ►�e�-. ��Kna� (-�, dem <br />V4) <br />n0 �atvI(1y 6yhav f Own, �sert 'i"0 �n <br />