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016 <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 718 -4631. 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 />_ 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 />NAME: W i 11 t h M Q. f f9 Tf S <br />MAILING ADDRESS: / OS - A-9CK 14 -a wCE - ZdWe S'A&E00-0, N C• 7 33 1 <br />HOME PHONE: WORK PHONE 9 -317.1 E - MAIL 19 b l e2 l (0 Y,ANoo • CO/N <br />YEARS LIVING IN <br />LEE COUNTY: S DISTRICT YOU LIVE IN: C� RFfif/ w o oh <br />MALE: X FEMALE: _ WHITE: X_ BLACK: HISPANIC: NATIVE AMERICAN _ OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: RET RE 4 <br />OCCUPATION: PH yS)CAL nWie do O /ST <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />RES7 IY&,4446 /10 f/I'SOAY &eft Ad <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 than two (2) Boards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. IZrDC -rER 609i LEI (, KE?e / 4f dF4A*w O 3 >32 d 7 76 - d l o -' E? <br />2. (✓ANCY /N U.tP//r Na 4e OGFeN4- *. P YiP SSA - ��� <br />3, ZA W FQ01k ? /O i POCK HOIArC [.v. S'4. ,O:ry _, M C v 94r - 3 <br />REASON(S) YOU WISH TO SERVE - W - fIM A P/1YS ;fe4 r71BR4A157 j Rt "RtT, //.V f}M <br />(Attach additional page if more space .: iNeecieci �T Cr F L �- } Q�,{•' 8��, <br />RrPREse� �r+fiE i <br />SIGNATURE: c .t1 Q <br />ay..v DATE: <br />If <br />NOV 1g2� <br />