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_ . . <br /> MAILING ADDRESS: <br /> • <br /> • . • Aar 5-0 AL../ ZIP CODE: <br /> • TELEPHONE: 3.;- 7e/ez HONE g.et-37-R BUS/NESS <br /> ETHNIC BACKGROUND: BLACK INDIAN WRITE )/L OTHER <br /> SEX: MALE • FEMALE 1.7 AGE: co? 7.7 <br /> EDUCATION: (HIGHEST) r3. <br /> OCCUPATION: ______ <br /> COMMUNITY INTERESTS AND ACTIVITIES: <br /> „. 1 <br /> IN WHICH TOWNSHIP DO YOU RESIDE? ! <br /> (not applicable in some ins . ces) <br /> I AM INTERESTED IN SERVING ON: . / <br /> • <br /> DATE; ' / SIGNATURE ./ eel <br /> RETURN TO: Clerk to the Board of County Commissioners <br /> 106 E. Margaret Lane <br /> Hillsborough, N. 27278 <br />