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CGI <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 _ Jury Commission <br />Agriculture Advisory Board _ Library Board of Trustees <br />Americans with Disabilities Act (ADA) /arks & Recreation Commission <br />_ Board of Adjustments (Lee County) _gyp Planning Board (Lee County) <br />_ Board of Adjustments (Sanford) _ Planning Board (Sanford) <br />_ Board of Equalization & Review Senior Services Advisory Board <br />_ Cemetery Board of Trustees Social Services Board <br />_ CCCC Board of Trustees ` Transportation Advisory Board (COLTS) <br />_ Economic Development Corp. _ Juvenile Crime Prevention Council <br />_ Fire Advisory Board _ Industrial Facilities & Pollution Control <br />_ Environmental Affairs Board Financing Authority <br />_ Board of Health _ Rest Home - Nursing Home Advisory Board (cannot have <br />_ Mental Health Board n ` a relative residing in a facility) <br />i�V <br />NAME: a_Y e-5 l� 31 J —( r. *� ,r� <br />f,�7 <br />MAILING ADDRESS: q a im J <br />' C � O 1V Y C 1 397, F <br />HOME PHONE: q l Lq-35L - 5- CORK PHONE: t 4'�r � � - MAIL 1V `� G VY�Bt1 .CC�m <br />YEARS LIVING IN c <br />LEE COUIjTY: Q �ISTRICT YOU LIVE IN: <br />MALE: _FEMALE: _ WHITE: BLACK: HISPANIC: NATIVE AMERICAN' OTHER _ <br />�qq <br />(information ity) <br />ff tion for the urpose of assuring a cross section of the commu <br />EMPLOYER: 'SC`if' C�.Y <br />OCCUPATION: S Vi1f LS 1�tir1L f! / SSlY / m riLf �l�1i11'2. �P.� <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 <br />+t THREE <br />�(((3) LOCAL PERSONAL REFERENCES AND PHO NUMBERS: <br />1. �1 GULE? —L4 Ila�.teS �f 1 7 74' 1 (S5 B p i <br />2. 41 vitry MCCy"A 0_,y1 4 1 . 1 TOE - 356 B <br />3. L so yAU tai H nyrAk_ s {m 9 15 7Z] - 5 0 S L <br />REASON(S) YOU WISH TO SERVE y P D tiytb <br />�=Fs a VL'Tl v�4{ +0 " +mot b e <br />(Attach ad tonal page CJ more space Is net <br />de �.� d) 77 {� <br />SIGNATURE: Lit I.QlUC @A> 1 ZAJ, 41.. DATE: <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />JUN 2 7 201�;� � <br />