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I <br /> APPLI~TION FOR NOMINATION <br /> <br /> NAME OF ADVISORY I~OARD]CO~MITT, EE]COMHISSION TO ~ICH PERSON IS NOHINATED <br /> <br /> iu ~t~ ~d~otF ce~tt~e~ ~d u~ges th~ public t~ <br /> No~nat~ ~y be sent <br /> <br /> Cabar~s ~cy Board of ~sstoners <br /> Post Office Box 70~ <br /> ~ncord, North Caroli= 28025 <br /> <br /> For ~re lnfo~aCion, applicants ~y revie~ in Che ~ty ~nager's Office the responsibili~les <br /> of various advisoiy bodies. <br /> <br /> OT~R CO~ BO~S/~I~EES/~SSIONS P~S~Y SERVING ON: <br /> TE~ E~I~TION DATE <br /> <br /> NOMINEE BACKGROUND INFORMATION: <br /> N,~a~ d'--e~-vv ~, ~i~ ,x. ~HO~ NO. 7~-I-~:5'~ <br /> H0~ ~D~SS ~o:~T4'. ~ ~X ,~c~-C_ , ~c..~w~/ ~. ~. ZIP CODE <br /> BUSINESS ~D~SS ~,~ ~.~,~ ~o ~1~.~, .~A~. ~-~.~l ZIP CODE <br /> OC~PATION ~,b ~t~--~.--,d,,~fi,..~o- ~.,: ~,al~ PHONE NO. <br /> <br /> ~cE ~i~. SEX ~/~ A~ ~ <br /> <br /> NO. HO~S ArAbLE PER ~NTH ~R THIS POSITION <br /> <br /> , - ~ · , , , <br /> <br /> BUSINESS ~ CIVIC E~ERIENCE/SKILLS /d~.(W '~ ~-~, ~ ~,9~o,~s' /; l~,,:,~ <br /> <br /> A~AS OF E~ERTISE ~ND I~E~ST/SK~LLS ~,~n~,-~ ,~ a ,~;~c ' ' - a ' "651. <br /> <br />r:~.).*c ,-2 ~.tJ t.. ;~t.,.~.~ ,.. ,'.v,/..,=~,~ ;~...~;~ ;~ ~,~ ~ ?.,... .... <br /> <br /> I understand that this application will be kept. on the ac[ire file for <br /> t~'o years only. <br /> <br /> ~ sig~ture ~e ~uulieant <br /> <br /> <br />