Laserfiche WebLink
Gu•� <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 />7— <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 />i U_\Lltl <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 />MAILING ADDRESS: a 60 a S He bb / e b a-0 0 1e U?- <br />4/ 9- <br />HOME PHONE: 7,10.0 q s/ WORK PHONE: —6— E -MAIL r I 3 0ti ca • coo is <br />YEARS LIVING IN A <br />LEE COUNTY: . 3d � rsDISTRICT YOU LIVE IN: � Leogu A9 <br />MALE: _ FEMALE: L WHITE: L , , ' BLACK: HISPANIC: NATIVE AME141CAN OTHER <br />(Information for the purpose of assuring a cress section of the community) <br />EMPLOYER: /SE-0 f� <br />OCCUPATION: <br />- _ & - n +-/ <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />%+sr /ASS /s /LYN <br />(Generally, the Board of Commissioners desires to broaden participation on Boards/Commissions for as much citizen invotvement <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. Mrs, D. -t-yt ma a- M 8 at_.a - 9/9 - g 9 5 = 0 51 <br />2. M r s A L 14 i w S h e - 1 ✓, 0 C.k <br />3. <br />e)- 52.5:.3 <br />REASON(S) YOU WISH TO SERVE / to C I< ro t1l Y- <br />.i <br />SIGNATURE: <br />if page if % Trespace k needed) <br />DATE: 6 — o?a — Z 6 / L, <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />JUN 2 5 2012�� ; <br />