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3 <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 />Mental Health Board <br />T 1 i'"/T&'g III W/A <br />MAILING ADDRESS: <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 />y Rest Home - Nursing Home Advisory Board (cannot have <br />a relative residing in a facility) <br />HOME PHONECI -- 77.5 = n l 3 D WORK PHONE.. / 9 7 2iS:2.336 E-MAIL k-, - tki,p,%-b1 j X In c� <br />YEARS LIVING IN �' ceV <br />LEE COUNTY: DISTRICT YOU LIVE IN: Ug <br />MALE: _ FEMALE: ✓ WHITE: ✓BLACK: HISPANIC: _ NATIVE AMERICAN _ OTHER _ <br />finfnrmatinn for the rnimnse of assurina a cross section of the communitO <br />EMPLOYER: <br />OCCUPATIOI <br />OTHER MUNICIPAL OR COUNTY BOARDS /COMMITTEES ON WHICH YOU ARE SERVING: <br />THREE (3) LOCAL PERSONAL REFERENCES AND PHONE NUMBERS: <br />REASON(S) YOU WISH <br />OF <br />(Attach additional page if more sA6 ce i needed) - / 1 <br />SIGNATURE: DATE: <br />NOTE: ALL TAXES MUST BE PAID IN FULL BEFORE BEING CONSIDERED FOR APPOINTMENT <br />NOV - 7 2017 <br />UJV <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 />