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Jun 27 12 11:56a B. J. Turner <br />9197751753 p.2 <br />C4S <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, 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 />X 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 />_ Mental HeaRh,Board _ <br />NAME: Z1 , 2 <br />MAILING ADDRES - <br />HOME PHONE: M_-]_', <br />YEARS LIVING IN , <br />LEE COUNTY: <br />MALE: _ FEMALE: WHITE: <br />EMPLOYER: 5 <br />OCCUPATION: 1 5A%/ fA. , <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 Horne Advisory Board (cannot have <br />a relative residing in a facility) <br />WORK PHONE: 2cl !Mi E -MAIL *4.< <br />DISTRICT YOU LIVE IN: <br />BLACK: )�,_ HISPANIC: NATIVE AMERICAN OTHER <br />oration for the PuTor of assuring a cross section of the community) <br />OTHER MUNICIPAL OR COUNTY BOARDSICOMMITTEES ON WHICH YOU ARE SERVING: <br />n/ !A nl Z- <br />kucumcny, u1c eaem or wmmissronem oeslres io Droaaen par opatron on BoardsfCommissions form much cdizm involvement <br />as possible; therefore per Board policy, appointees can serve on no more than two (2) BoardsfCommissians ate time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NU - <br />1. 66 aft aaZ - /�'/A ? — OFlr� (' I V'N-I16?7 <br />724 <br />REASON(S) YOU WISH TO SERVE <br />DATE: <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />111272012.,r <br />