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00049 <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 />NAME: iQ,,, ` CC xta e -(' <br />MAILING ADDRESS: o� <br />HOME PHONE: IQ <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 Home -Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />aLOeV, J<%Ver <br />WORK PHONE: <br />E-MAIL <br />YEARS LIVING IN <br />LEE COUNTY: �6 r 5 DISTRICT YOU LIVE IN: �2\t Vei <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: 1.."o �ig_&!Oe 6' <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 related to anyone currently serving on any County board/commission? If yes, please state name and board they serve on <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />913 Z -70 14 5 'j <br />2. 1 l *,a Y.,./ � t 1 na I� "728 <br />3. f � kE <br />REASON(S) YOU WISH TO SERVE <br />C•-NcQ _T c-,� 5 �1.1 <br />9 i 7q6 rN X11 <br />f',J A w r ( C Lq-ft-V__ <br />(Attachadditional pa i o�%r spa eded) —' iJ U �j <br />SIGNATURE: � ( 6fi�DATE: I — I 1 <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />THIS APPLICATION IS CONSIDERED A PUBLIC RECORD <br />