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�IU�f <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, please <br />complete the form below and mail to Clerk to the Board, Lee County Government Center, PO Box 1968, Sanford, <br />NC, 27331 -1968 or fax to 7184631. YOU MUST BE A RESIDENT OF LEE COUNTY TO APPLY. <br />BOARDS AND COMMISSIONS <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 />NAME: <br />_ Jury Commission <br />_ Library Board of Trustees <br />_ Parks & Recreation Commission <br />Planning Board (Lee County) <br />_ Planning Board (Sanford) <br />_ Senior Services Advisory Board <br />_ Social Services Board <br />_ Transportation Advisory Board (COLTS) <br />_ Juvenile Crime Prevention Council <br />_ Industrial Facilities & Pollution Control <br />Financing Authority <br />Rest Home - Nursing Home Advisory Board (cannot have <br />a relative residing in a facility). <br />MAILING ADDRESS: � �� jJ 14 <br />HOME PHONE /� 77& S V461B)CPHONE: <br />r/ S <br />727 - °70 E -MAIL <br />YEARS LIVING IN <br />LEE COUNTY: �S� DISTRICT YOU LIVE IN: d Q <br />MALE: MALE: _ WHITE: _ BLACK: __ HISPANIC: NATIVE AMERICAN OTHER <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: <br />OCCUPATION: <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />I 017E — Utr •nr� <br />(Generally, the Board of Commissioners desires to broade participation on Boards/Commissions for as much citizen in <br />as possible; therefore per Board policy, appointees can se a on no more than two (2) Boards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENC AND PHONE NUMBERS: <br />� � r LTRY ✓ M �ec�hnA�f/ �Y -E-�r✓ � /� �7� � ZZ_ <br />2. 1Ja/ <br />KI <br />REASON(S) YOU WISH TO SERVE <br />SIGNA' <br />DATE: <br />OCT 3 1 20 <br />