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0 <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 />• <br />11 <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 />Transportation Advisory Board <br />_ Environmental Affairs Board / <br />Juvenile Crime Prevention Council <br />_ Board of Health <br />Criminal Justice Partnership Advisory Board <br />industrial Facilities & Pollution Control Financing Auth. <br />NAME: <br />MAILIN( <br />7G <br />i./S <br />HOME PHONE:- l'• - -4zA&, 6 WORK PHONE: 91 77y-(~1ZL E-MAIL <br />J <br />YEARS LIVING IN i.-Z, <br />LEE COUNTY: )24 DISTRICT YOU LIVE IN: -i-tea ; <br />"`_i J,„e I , deco <br />MALE: _ FEMALE: ~ WHITE: BLACK: _ HISPANIC: _ NATIVE AMERICAN OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: lee l.n.(')f., 5['11 co{S <br />OCCUPATION: 11';r Zi {nr L S~n{r.x4 _SCry ,'ceS <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 the two (2) Boards/Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />2. U;t k. Fl ,.r/; n 7E - U.S"OC <br />3. c'5 . Mi n ~t '7/cr 02 ~0 0 <br />SIGNATURE: (I.,-) ✓~f•?l DATE: ~c X 9 o?nio <br />T <br />