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APPOINTED OFFICERS (continued) <br />• A copy of the form must be provided immediately to the other members of the agency. <br />® The form must be read publicly at the next meeting after the form is filed. <br />IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: <br />You must disclose orally the nature of your conflict in the measure before participating. <br />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 <br />meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the <br />agency, and the form must be read publicly at the next meeting after the form is filed. <br />1 EDMUND BAKALLA hereby disclose that on MARCH 10 ;70 21 <br />(a) A measure came or will come before my agency which (check one or more) <br />inured to my special private gain or loss; <br />— inured to the special gain or loss of my business associate, <br />— inured to the special gain or loss of my relative, <br />— inured to the special gain or loss of by <br />whom I am retained; or <br />inured to the special gain or loss of <br />is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me. <br />(b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: <br />ZB-20-06 Rezoning of 380 SR 436 and Parcel ID: 17-21-30-300-025N-000: Property is adjacent to the my <br />Carriage Hill Community (atleast three properties directly and will be visible by much of the community when <br />leaving one entrance) which is represented by Carriage Hill Community Association (CHCA) which I am the <br />Treasurer for over 12+ years. As part of the CHCA board before and after our annual meeting in April 2021, the <br />board and community members will be having numerous discussions on this topic including whether to oppose or <br />ask for changes to this zoning or any P&Z cases/presentation for this property. Based on discussions with the <br />city provided attorney at the P&Z meeting, this does present a clear appearance of a potential bias based on FL <br />Statute 286.012 and so I abstained on 3/10/2021 from the above ZB-20-06. I presented to the whole board <br />before the above meeting during "Disclosure of ExParte communication" that I would be abstaining from this <br />ZB-20-06. EB 3/15/2021 <br />, which <br />If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer, <br />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 <br />as to provide the public with notice of the conflict. <br />3/15/2021 <br />Date Filed <br />4,� Signatu <br />NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE <br />CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, <br />REMOVAL. OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A <br />CIVIL PENALTY NOT TO EXCEED $10,000. <br />CE FORM 8B - EFF. 11/2013 PAGE 2 <br />Adopted by reference in Rule 34-7.010(1)(f), F.A.C. <br />