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0 6 <br />rM L <br />- -- - - - - <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, <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 />0 <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 />_ Economic Development Corp. _ <br />_ Fire Advisory Board _ <br />_ Environmental Affairs Board _ <br />Board of Health _ <br />_ Industrial Facilities & Pollution Control Financing Auth, <br />Jury Commission <br />Library Board of Trustees <br />Mid - Carolina Workforce Development Board <br />Parks & Recreation Commission <br />Planning Board (Lee County) <br />Planning Board (Sanford) <br />Rest Home - Nursing Home Advisory Board <br />Senior Services Advisory Board <br />Social Services Board <br />Transportation Advisory Board <br />Juvenile Crime Prevention Council <br />Criminal Justice Partnership Advisory Board <br />NAME: MAAI/- /P ✓ In <br />MAILING ADDRESS: <br />HOME PHONE: '/10'5 WORK PHONE E - MAIL <br />L 7— <br />YEARS LIVING IN ���,, A <br />LEE COUNTY DISTRICT YOU LIVE IN: �1 <br />MALE: FEMALE: 1 NHITE: _ BLACK: V HISPANIC: NATIVE AMERICAN OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: Ao lidt& 5&E HA✓Ict &607e/Z- )Oe <br />OCCUPATION: Qu,A�fT(M�;d�CMeNi l.ritiN /N�T�;,zG27o� <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />�rhm" ce" <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. ldM UVf Mtn / 33(p 26 -7 lbrn <br />3. LEI C T ✓� 17 Jr <br />SIGNATURE: –Z el l <br />• JAN 3 1 201 <br />7 <br />