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r, <br /> 080 <br /> 1 <br /> 1 <br /> i kcE� iti ic. <br /> g / .r <br /> L 1 CJ ,eze. rte 'f <br /> Name: ____Jens., . ' Doi war• _ <br /> Mailing Address J 1.39 gurds al _Road__________ <br /> Hillsbarou:h N.;C. <br /> Zip Code <br /> 967--7C1 __. usile5s <br /> Telephone: 732-8380 Home,,- - <br /> Uhite Other <br /> Ethnic Baekgrouind: Black Indian . -• . . <br /> Sex: Male xc Female ,Age: • . r <br /> g . 0110 <br /> Education: (Highest) . • <br /> 1 - . Hea. 0 Congo '..ie� .♦ 'Inc.: <br /> Community Inte ests and Activities: I have I`ved • 11 ^ . . -• " <br /> ' D11rJ.�1: that n r . - - • <br /> • <br /> borou:h for 15 of the - <br /> . •aixss of our town.� <br /> to kee. abreast of tR - • - r a*• •- 0 -' " '. . <br /> T . 110W + • <br /> M a •eriGfde in pas_ • - r... - j - *01. • : • = <br /> • <br /> ' �r .C) " 111 • - 'r _ r .• • ro <br /> the past 'ear' or so' 11— ^ .•.. r - r - <br /> how the Baatd -operates . , • : <br /> In which totia�nIhip do you reside? I S.. e .• ,� ' r : `« : - , ♦-• • a . <br /> . - (not applicable in some instances) " <br /> 1111 1111 . <br /> sub-:division located a •- t. .t11 '1111 :- - - ^ ,'•,r' .. a 7"e. <br /> A. . ��. 11 1111 z` wish to <br /> :.. : ': <br /> I am interested in serving on: - . <br /> • - o <br /> - 1 . .. . <br /> serve on t•i. • • . a : _ _ . a act 1111 r. and sii• <br /> Olin corn IL1Tl L� ,' • <br /> • <br /> • 1111 , <br /> . r . <br /> ., 1111 ., 1111 1111 l 1111 ., :," <br /> 1 Signature - 4.- •,,.� <br /> Date: <br /> Jwne �/ . <br /> m <br /> � . - 1111 : <br /> Return to; Cierk to the Board of County Commissioners <br />