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1 <br />COUNTY OF LEE <br />APPLICATION TO SERVE ON BOARDSHCOM MISSIONS <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 Health Board <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 />NAME: rya( <br />MAILING ADDRESS: 4 1Y, 4d Ai V f'^, 490lffiillibr. Q .AD r t /lhZ� ✓✓ e <br />1 7So f <br />HOME PHONE:9 WORK PHONE: E -MAIL <br />YEARS LIVING IN <br />LEE COUNTY: —� � DISTRICT YOU LIVE IN: C,44f FE'gg <br />MALE: -FEMALE: K WHITE: K BLACK: HISPANIC: NATIVE AMERICAN OTHER _ <br />(Information for the purpose of assuring a cross section of the community) <br />EMPLOYER: , tee I — C iH/ y Zdw <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 than two (2) Boards/Commissions at a time. <br />PLEASE LIST THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />1. 'dB .57a c& 2" - 9 g .Z .Z <br />2. nM WELBiJeN 9/9 - Y7&' - r &V <br />3. g42oL0 it 4Qe n.67av 91 9- ?-5d -66 ?� <br />REASON(S) YOU WISH TO SERVE - r2l Cµ <br />LEr Co. -_' Sr'Rvhb a. <br />(Attach additional page if more space is needed) <br />SIGNATUR ATE: 06 — a 7 — <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />JUN 18201 <br />i <br />