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RANGE COUNTY RESIDENTS APPLICATION MgrK Gtnsbe* <br />COUNTY BOARDS AND COMMISSIONS <br />Date:__,y/!1_97------- <br />Name.- / <br />------?-------------------------- - <br />:3treet• Z 7z o -RD---------------------------------- <br />Z i pL5?3?,eoNGM . Z7a 79 <br />Town:_--_________....___ ----------.------ •---------------- <br />Telephone: Day: c177' 2193 Evening: -73 ' y6 2" <br />Ethnic Background: Afro American_ ,r Caucasian___ <br />Native American Other -------------- <br />Male ? Female Date of Birth <br />?l/I??fl ?,?',2 - c,¢Rb 4CN °RI „/ Ti n/ Cy , Du,?ltst?/ <br />--- ---- - ------------- <br />Occupation:.._ _______------------------------ <br />-, C6,41M LN />ry C Nt/,2C 0,? G{fif ?L fy/?L: <br />Community Interests and Activities: _____. _--_---- hEMr3rc-) <br />Socl?c, co?Ic?Qn/S coF?EE ousE PRopucT,.,? cd?,M / 7r"?'FS C <br />nE%_01 AI of IrIQI 4, ASZr4112.S Ca-?ov.?? _or__u_Nir1f ei? _UN_t Vc',eg?f1WS7-con/&I-664 <br />fir( IR-or c0,*7t1/9TC4r C!? <br />o F rfi? L-5- g aRO u G N rE,?c ?? o.J ,.v T-/?T.g 77 an!? L s r"?' <br />uu n1eTw6,al< op) /. 4P1Cret"d(X5 <br />Y'ka?cf.ETB?u.??'`fK1ic%i?1`--_ -- <br />Township of Residence: <br />' ham <br />?NB g <br />Eno <br />Little River <br />Cedar Grove <br />Chapel Hill <br />-Cheeks <br />40 Hillsborough <br />Do you reside in the extraterritorial area of a municipality <br />yes no 600swAcy) <br />Please list in order of preference Board/ Commission(s) on which you ?c <br />would like to serve: Q oes <br />A AA <br />el? G? <br />4 eSu.rre5 CromnP o 2a ' 2&,6-1 ! C T1__P?,gn/?%/idG <br />?' JIl?2/9 d b ? -- <br />Remarks: ,b--------------- _1?E_c_E_l? _----/d,J,Pedi/T <br />M?in1,¢GEME? r ,?RaM Dflk? t-?N t ?. l,B. ?- /NT?a???7"/on/.4G /? ?ifT/4N.S' IT <br />cOrrP REL. sac/OLo?Y _- <br />Lel'F .2 ycs_ G" v SeJ? /W /NT <br />_-_d Co v- _! :tt --------------------- <br /> <br />Signature: ------- ----------- J r ---------- <br />Return to: Beverly Blythe <br />Clerk to the Board of County Commissioners <br />P. O. Box 8181 <br />Hillsborough, NC 27278 <br />