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• C~~1-U\ <br />• '' ~ «~~~u~ OFFICE USE _ONLY ~ ~•~ <br />RE EI ED <br />ORANGE ,COUNTY RESIDENTS <br />APPLI CATION <br />FOR SERVING ON '. ' <br />COMMISSIONERS' APPOINTED <br />BOARDS AND COMPiI$SIONS <br />._ I <br />Name : ~ <br />Mailing Address: ~~ ~ / ~~ ~S r`C.~• Zip Code: ~~S` <br />Road or Street Name: _.,f "'l~(~~ ~ ~ 1.~. <br />Telephone Home: '~ 3~•~ E_ ~ q / ~ Telephone Business: <br />Ethnic Background: Slack Indian White ~ Other <br />Sex: Male: ~ Female:~O•~ Date of Birth: ~~' 2 G " ~ <br />.Occupation: <br />Community Interests and Activities::,,,•,_ ~~; ~ P ~ ~ T19~ <br />Hingham <br />Hillsborough ~~_ Little River. Is your residence in the <br />extraterritorial area of a municipality? ~ Yes ~~ Na. <br />On the reverse side of the 2pplication rank the Boards/Cominissiaris <br />the order of interest, with ~ 1 being tha first choice of volunt~ <br />service. •' <br />Date • ~ ~ • ~ o? • g Q Signature : ~ <br />Return to: Beverly Blythe <br />• ~ Clerk to the~Hoard of County Commissioners <br />109 Court Street <br />Mailing Address: P.O. Box 8181 <br />• Hillsborough, North Carolina 27278 <br />Cedar Grove ~ Chapel Hill Cheeks -Eno <br />