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<br /> MAILING ADDRESS: ' ' ...,, - O
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<br /> TELEplioNE: "... $,Z.174BiLgoliE b..qr/.. ,/e;c5 BUSINESS
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<br /> ETHNIC BACKGROUND: BLACK INDIAN WHITE A.,-"d'...-OTHER
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<br /> SEX: MALE -/ FEMALE -AGE: *5 6
<br /> EDUCATION: (HIGHEST) ii c,/.
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<br /> OCCUPATION: jir
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<br /> COMMUNITY INTERESTS AND ACTIVITIES:
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<br /> IN WHICH T1WNSHIP DO YOU RESIDE? ... e.,„(
<br /> (not applicable in some instances)
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<br /> 4 AM INTERESTED IN SERVING ON: „.
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<br /> DATE: OIO ie,2- SIGNATURE:taregen.„. l./..— /././...a.' / •
<br /> RETURN TO: !Clerk to the Board of County Commissioners
<br /> 106 E. Margaret Lane
<br /> Hillsborough, N. C. 979/0
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