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023 <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 />Sanford -Lee County Airport Authority <br />_ Jury Commission <br />_ <br />Agriculture Advisory Board <br />Library Board of Trustees <br />Americans with Disabilities Act (ADA) <br />_ Mid- Carolina Workforce Development Board <br />_ <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 />_ <br />_ Cemetery Board of Trustees <br />_ Rest Home - Nursing Home Advisory Board <br />CCCC Board of Trustees <br />_ Senior Services Advisory Board <br />_ <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 />_ <br />_ Board of Health <br />_ <br />_ Criminal Justice Partnership Advisory Board <br />s & Pollution Control Financing <br />_ Industrial Facilities <br />th <br />Au. <br />NAME: oh ..V es � e),bw Ll <br />MAILING ADDRESS: a3 (64)o,9b <br />• HOME PHONE: ) WORK PHONE: MAI� <br />YEARS LIVING IN <br />LEE COUNTY: DISTRICT YOU LIVE IN: <br />MALE:ZEMALE: — WHITE: LACK: _ HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />( nf"hoation for the purpose of assuring a cross section of the community) <br />EMPLOYER: A Z- YG h 11,1 6 ti <br />OCCUPATION: /tiq/I�NE <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 PERS NAL REFERENCE AND PHONE NUMBERS: <br />1. W�7h P,����� �7y�- 3i�c <br />2. 7E V, <br />3. 6 Pis 3� <br />SIGNATURE: / DATE. �/ 0 <br />DEC - 2010 �L' <br />