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024 <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 />_ Agriculture Advisory Board A <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 />_ <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 lh <br />Control Financing Au. <br />al I- <br />2.S 4- L_P_h <br />NAME: c/ n mo_n )9 <br />MAILING ADDRESS: [ njpA, 1 4D S Say -i ord <br />INS 7331 <br />HOME PHONE: WORK PHONE <br />E -MAIL <br />YEARS LIVING IN <br />LEE COUNTY: 5.A DISTRICT YOU LIVE IN: <br />MALE: X FEMALE: WHITE: X BLACK: _ HISPANIC: <br />NATIVE AMERICAN OTHER <br />_ <br />(Information for the purpose of assuring <br />_ <br />mu <br />a cross section of the community) <br />EMPLOYER: <br />OCCUPATION: R C�V r P r] <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES <br />nvn e- <br />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 <br />two (2) Boards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. Herb Htn`1<5 'I �5 - 3523 <br />2. taco Carte-i' 7 <br />3. I I t l Sts- /VI cL C- h l k - 7 71-5737 <br />REASON(S) YOU WISH TO SERVE L kcLv e voir�n oel,ed fai Se.vt?k L.1 0o A ( qe. - eot <br />(Attach additional page it not enough space) I 1 ' <br />hl'cllik fYU� y- <br />5 lt-. Y1 Li enlo.I eCl w0 l < Wlfih"Cln C' <br />II StZL�f " <br />SIGNATURE: y "61q(.t- / ntEn�ln'L DATE: ,2- <br />FEB 1 4 2011 <br />f ! �r <br />