CC 02/23/2015 Minutes - Laserfiche WebLink

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APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. • The form must be read publicly at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the agency, and the form must be read publicly at the next meeting after the form is filed. DISCLOSURE OF LOCAL OFFICER'S INTEREST hereby disclose that on �/,2,� �d6 20 IC- (a) C(a) A measure came or will come before my agency which (check one or more) _ inured to my special private gain or loss; inured to the special gain or loss of my business associate, ba ijj 'erc/lAa5kinsein inured to the special gain or loss of my relative, ! inured to the special gain or loss of by whom I am retained; or inured to the special gain or loss of is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me. (b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: , which If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way as to provide the public with notice of the conflict. a /is _'41g)v Date Filed Signatur NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, ORA CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 813 - EFF. 11/2013 PAGE 2 Adopted by reference in Rule 34-7.010(1)(f), F.A.C.