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<br /> RESUivrEt ,.
<br /> Name of Nominee: 2 I Q i C AP"/I-re CI '-
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<br /> Mailing Address: / ecte„ c, .:7:
<br /> I ) , L I ,./. fe Zip Code
<br /> Telephone: Home, 2-.39// Business gr71.2 ;2-F ?' 7
<br /> Ethnic Background: Black Indian White C,...------ Other ,
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<br /> Sex: Male. ."-..-1,, Female
<br /> Age:
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<br /> Education:i (Highest) 42 67)47/1-ri--Q-- ....
<br /> Occupation: .040(k/
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<br /> Community Interests and Activities / I
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<br /> , . -e.43 /21 ,, ,./)— ..0(I A/
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<br /> Nominatee, to Reniesent what area of County 73 ,,y/1,4- -1 7ee4/y,,,,to
<br /> (Not applicabi; in some instances)
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<br /> Boards on which I am interested in serving are: _ _
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<br /> Date: 9 it_____, g--3 Signature of Nom* e i
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