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Tor OFFICE USE ONLY I g"r <br /> A P P L I C A T I O N <br /> FOR SERVING ON <br /> COMMISSIONERS ' APPOINTED <br /> BOARDS AND <br /> COMMISSIONS <br /> Name: I/ /rte. /r %/ "7-777e- <br /> Home <br /> Address: 5f<J 4 7 ICJ C) <br /> " � <br /> � ice'Lf Z ip Code: 1 7,j 6) ;;;.% <br /> Telephone Home: ✓' 373-/77// , Telephone Business : <br /> • <br /> Ethnic Background: Black // Indian White Other <br /> Sex: Male: Female: � Date of Birth: 2— 2,- /.2 <br /> Occupation: (�2�G� .�_.��. <br /> Community Interests and Activities: <br /> 4 <br /> Please check the Township in which you reside: Bingham <br /> Cedar Grove Chapel Hill Cheeks Eno <br /> Hillsborough Little River <br /> Check those Boards/Commissions on the reverse side of this application <br /> that you are interested in serving on. <br /> Remarks: <br /> • <br /> Date: '7� �� Signature: <br /> Return to: Beverly Blythe <br /> Clerk to the Board of County Commissioners <br /> 106 East Margaret Lane <br /> � <br /> Hilisborou h North Carolina 27278 <br /> Hillsborough, <br />