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. , <br /> -„, •: - <br /> -......:.-:;.....:-' . ',:. .?...7"";T•., <br /> - <br /> TOWN OF CHAPEL Inn <br /> ctlitiPe' <br /> APPLICATION FOR BOARD/COMMISSION MEMBERSHIP <br /> Please complete and return to the Office of the Town Clerk, Municipal Building, 306 <br /> North Columbia Street, Chapel Hill. This information will be kept on file for six . <br /> months. <br /> NAME ..-0/(A./4i re../P 1/1//6•>le DATE 4082 /ilaj2a <br /> ....____________;_, <br /> , • 1, <br /> ADDRESS Z. <br /> _, <br /> .. ._ . <br /> -- •— • <br /> TELEPHONE (Home)._ 9' 1,5' <br /> 3'3 -OP (Office) 9 .9 - 7283 <br /> 1 <br /> The following questions enable us to ensure variety of representation on Boards and <br /> Commissions: I <br /> i / • i . . <br /> Age_a_ Race Sexg Occupation Tee tired — CaroSe..hecri:/ try 4:Ls,e,,,-gle. <br /> 4 *re,x.. o 4-A4 iee H ..zy <br /> Length of residence in Chapel Hill / r <br /> i <br /> Reside: ____ WITHIN corporate limits <br /> P."--- OUTSIDE corporate limits but within Planning Area <br /> Please check the Board(s) or Commission(s) on which you would like to serve: <br /> fr-- Board ofi Adjustment <br /> i <br /> Community Appearance Commission <br /> - —Historic District Commission <br /> .--- Human Services Advisory Board <br /> Library!Board of Trustees <br /> 1 <br /> V Orange Water and Sewer Authority <br /> v Parks and Recreation Commission <br /> Personnel Appeals Committee <br /> Planning Board <br /> 1 <br /> Transportation Board <br /> Served on other Town Boards or Commissions <br /> ■ <br /> Please state why you 'wish to serve on the above Board(s)/Commission(s). Discuss <br /> any experience you have had which may support your application. A.s. 4._ c 0 aise fr.heti <br /> a Aid ;hie reS real 4/../71' 0 4.•7,4 new re'S;ell IL/ / 1-00(.../CI A'ke ile) 404.44.4.-E <br /> Scaste c.o al 11-1.g41,4e; 710 ...V.4 coAdAnt.0.7.1t1 ',G1,414 es_ c1/1'/ <br /> ecitecpero-k (e„ /5 v) p4s. <br /> - y ex,oer-venc.e <br /> oi ya yes.g.„ ' 014,44erirA lai.e/; t/e IXf/ <br /> L ,I __/ . i 7( <br /> L'fe.0'; 4.114 Alt ec7 y Itoye Psi,0 it a.a e 43 A 4 Si Se.i.C. <br /> 1 <br /> -4-r- 7/Ae Work' a P-11 ha sict. <br /> A X '0 <br /> -74)/(Yeat9/ 11PitYZA <br /> . . .._ <br /> , <br /> . - <br /> - • <br />