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I <br /> <br /> NOTICE OF APPOINTNE~T BY COIIKI~ COHHISSIO~RS TO THE CouKrY BOARD OF SOCIAL SERVICES <br /> <br />Date <br /> <br />Co~m~:y <br /> <br />This is to notify the State Social Services Division that, the County <br />Comaissioners of the above-named county have named as their appointee to the <br />Board of Soclal Services to serve for a term of three years the £ollo~in§ <br /> <br />Name: <br />Address: <br /> Zip Code <br />Effective date of appointment: <br /> <br />Date of oath of office: <br /> If appointee is a County Commissioner, an additional oath is not <br /> <br />Race: County Conu~issioner yes no <br /> <br />Signature: , Clerk <br /> Board of County Commissioners <br /> <br />Please return this form to: <br /> <br />Nra. Bonnie R. lllred <br />State Division of Social Services <br />325 North Salisbury Street <br />RaleiEh, North Carolina 27611 <br /> <br /> <br />