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P. ECORD OF APPOINTmeNT TO THE REGION F AGING ADVISORY CObtMITTEE <br /> <br /> Appointed by / / Council on Aging <br /> Term: October 1979 to October 1981 <br /> <br /> / / County Board of Commissioners <br /> Term: October 1978 to October 1980 <br /> (filling unexpired term) <br /> <br />Date Appointment b~de <br /> <br />Authorized Signature <br /> <br /> / / Chairman County Commissioners or Clerk or <br /> Other Appropriate Person <br /> <br /> / / President of Council on Aging <br /> <br />Appointee's Name <br /> Address <br /> <br /> Telephone <br /> <br />Appointee's Name Submitted by Title III Project Director <br /> <br /> Title VII Project Director <br /> <br /> Council on Aging Member <br /> <br /> Other (Identify) <br /> <br />Appointee has been contacted and a~rees to serve on the Regional Aging <br />Advisory Committee / / Yes / / No <br /> <br />Note: The information requested above is needed for our files. Thank you <br /> for your assistance in documenting this appointment. <br /> <br /> <br />