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RECORD OF APPOINT~NT TO THE REGION F AGING ADVISORY CObSMITTEE <br /> <br />Appointed by / / Cou6cil on Aging <br /> Term: October 1977 to October 1979 <br /> <br /> / / County Board of Commissioners <br /> Term: October 1976 to Odtober 1978 <br /> (filling unexpired term) <br /> <br />Date Appointment }~de <br /> <br />Authorized Signature <br /> <br /> / / Chairman County Commissioners o~ 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 agrees 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 />