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009 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOAR DSHCOM MISS] ONS <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 <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 />Y, 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 />_ 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 Control Financing Auth <br />NAME: <br />MAILIN( <br />HOMEPHONE: /I - ,,Ss WORKPHONE: M 80 E -MAIL & 1` 61 V1dd 3 C ' ) I 1U(Mal 1 '('bYy) <br />YEARS LIVING IN <br />LEE COU. DISTRICT YOU LIVE IN: L ee, 0 y <br />MALE: _ FEMALE: _ /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 />(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 tm (2) Boards/Commissions at a time. <br />LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />2. / v t�l(,gan 703 -M) -67 <br />L/ <br />3. Gary t;t_u Aden 9 / 8 / ! - Ot' 0/ / d <br />REASON(S) YOU WISH TO SERVE I <br />(Attach additional page if not enough space) <br />-, <br />/\ <br />SIGNATURE: ( Y v� <br />1G UN A(�CSCI)alfu VfDble <br />re. -t - o f ry / o l7ef� T. �lP <br />�0el'( � (5 0,P ;r�t^ch day 4— eOe <br />DATE: —� a 0 119 <br />JAN 19 20- /J <br />