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COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDS/ /COMMISSIONS <br />019 <br />• If you are a Lee County citizen interested in serving as a member of one of the C Advisory Boards, <br />please complete the form below and mail to Clerk to the Board, Lee County Government Center, PO Box-1 968 <br />Sanford, NC, 27331 -1988 or fax to 718 -4631. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <br />C J <br />0 <br />_ Sanford -Lee County Airport Authority _ <br />Jury Commission <br />T Agriculture Advisory Board _ <br />Library Board of Trustees <br />Americans with Disabilities Act (ADA) _ <br />Mid - Carolina Workrorce 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. _Social <br />Setiices Scar <br />_ Fire Advisory Board _ <br />Transportation Advisory Board <br />Environmental Affairs Board <br />Juvenile Crime Prevention Council <br />X Board of Health _ <br />Criminal Justice Partnership Advisory Board <br />Industrial Facilities & Pollution Control Financing Auth. <br />NAME: (A►i )Ij4 AA C. U RTES <br />Pv1AILINGADDRESS: / 0S PR(K N 4191y ',_.VA F W h l� 73 <br />HOME PHONE: 9 /`�`S� I ��/ WORK PHONE: 919 - 30. 2 3j1 E -MAILb a f? / ®YAItOD < aM <br />YEARS LIVING IN <br />LEE COUNTY: 0 DISTRICT YOU LIVE IN: �R_E_ W 000 <br />MALEX FEMALE: _, WHITE: _ BLACK: HISPANIC: NATIVE AMERICAN OTHER <br />(,Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: Qe/ geo <br />OCCUPATION: PHY, Ikdl- 771EW191 / <br />OTHER MUNICIPAL OR COUNTY BOAR DS /COPAIMITTE ES ON WHICH YOU ARE SERVING: <br />;Generally. the Board of Commissioners desires to broaden parnapanon on uoarosrcommissions for as much cmzen <br />as possible; theretme 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 />1. ROGER l3i9ity, Tear- jpi, erTrR 22IE oe 7YT5p 9/9- <br />2. 1Q�.J SrR�Lf y yuNt�cviSoR of SF�N�i7), C07'y 7/9- 770 - -0612 <br />3- yn cy Kira& DiRzem 1£F Cc ,C�o�9kn of ��i 9/9 3S - <br />REASON(S) YOU VJiSH TO SERVE 7 v Gt _ �'d2T 7y N CFFrk`TS O Fr <br />(Attach additional page if not enough space) P� CFj� v• - •r <br />�'o�w'trsSiiNEel i N i/t'tP�O ✓ivG �u/i Cfo / ��GTj� <br />SIGNATURE: DATE: 02 ^ W /Y <br />4 <br />FEB 1 1 20 t a <br />i <br />