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I M.S UMIL, <br /> Name of Nomine T: J o <br /> mailing Addres : C 1-1:eL ep IA I I <br /> Zip Code <br /> Tel--Phone : Home 1 4 Business 6419 IR 3 -11 <br /> Ethnic Background: ]Black Indian V.1hite Other <br /> Sex: Male Female <br /> Age: <br /> Education: (Ilighest) <br /> occupation: <br /> communi-E'y interes-1--s and Activities <br /> Nominates, to Represent what area of County-U-)n4-PIOLY), <br /> (Not applicab-_e in soy4e instances) <br /> Doards on Tahich I am .interested in serving are; p S.A <br /> ee <br /> D a�L-e -7 <br />