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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 />Mental Healt oar� / <br />NAME: / J. �GPur <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 l <br />Financing Authority <br />_ Rest Home - Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />MAILING ADDRESS: d I0 "116-o GG e " v<- r <br />HOME PHONE: 'ST / WORK PHONE: //D �7� OS67 E -MAIL s�rK�, t„ �� wtu %/' CC)Wl <br />YEARS LIVING IN <br />LEE COUNTY. ;_ DISTRICT YOU LIVE IN: <br />MALE: FEMALE: WHITE: /BLACK: _HISPANIC: _NATIVE AMERICAN _OTHER <br />/1 (Information for the purpose of assunng a cross section of the community) <br />EMPLOYER: J <br />OCCUPATION: <br />OTHER MUNICIPAL �� C UNT // BO /COMMITTEES ON j WHICH Y ARE SERVING: <br />C ity S QN TOfIX gri 5ld (� PI je'r ✓4 , NW 1 0/A <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 />/ <br />1. d - 1 / 9 - 3s - 6 - 0:53 <br />2. la��e /��,'ce 91 TF3 Ike7 <br />3. �/o .. �- 1 ,2 X3 <br />R S / ON(S) YOU WISH TOSERVE � roe✓ / cSTr i` /v Lnne� r6a^ ((_ <br />`1 7T lG /pre / e ��r Nn ec r E %/ !�� COc�l1 (� /C <br />(Attach additional page if m re a e i ed) <br />SIGNATURE: DATE: fu�t� 2. ,2/J/ <br />NOTE: ALL T ES MUST BE PAID I LL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />JUN 2 5 20(Z, <br />