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G51 <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 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 />HOME PHONEJ WORK PHONE: NSA E- MAIL. CCZ 57*A/4.Ni7 <br />aWTUR14Al LeIIk <br />LEE COUNTY: 0(5'' DISTRICT YOU LIVE IN: LAhPC YPA9 R <br />MALE:x FEMALE: — WHITE: X BLACK: HISPANIC: NATIVE AMERICAN OTHER <br />(Information for the ng a purpose of assud cross section of the communi ty) <br />EMPLOYER: iQE7iRE� <br />OCCUPATION: y �FS/1�w/1 �/�i1M�ie,✓ &4E (.21 <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 than two (2) Boards /Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. Ao[�[c, [�lAov, P — 7d 5L &,f XW&4of YPR. <br />2. <br />3. <br />I/ <br />— 7/7— •fulSi <br />REASON(S) YOU WISH TO SERVE T cSE ✓E &4 OiCOPalae OkiNV& /W ZEE - 4a*ry /n/ <br />r <br />Ig ,4 'A 14 4mbfoyrno e AtAoy v g fOtlQW1'Ad 6_5 3TA7g YL-Zo q/ .QVCCT <br />(Attach additional page if more space is needed) <br />SIGNATURE: /t /fi.I y� c = A� DATE: V eZ0 /Y <br />JUN 2 6 201 <br />