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07 <br /> North Carolina State Historic Preservation Office <br /> CERTIFIED LOCAL GOVERNMENT PROGRAM <br /> 1998 Year-End Report <br /> I. CLG Preservation Commission <br /> A . Preservation Commission Profile <br /> 1 . Name of preservation commission : <br /> 2 . Name of CLG designated staff member : <br /> Title : <br /> Address : <br /> Telephone : Fax : <br /> E -Mail : <br /> 3 . Attach a list of the names and addresses of current preservation commission members . Indicate <br /> officers . <br /> 4 . Affirmation that residency requirements are met . <br /> I, the CLG designated staff member, affirm that each preservation commission <br /> member resides <br /> within the territorial jurisdiction of the CLG. <br /> Signature of CLG designated staff member Date <br /> i <br /> citcoff;=Cd" <br />