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jolpxelgo 14A S : i LAST NAME: -r 1RST NAME --MIDDLE NAME NAME OF BOARD, COUNCII_, COMMISSION, AUTHORITY, OR COMMITTEE BAKALLA-EDMUND-DONALD PLANNING & ZONING COMMISSION - LPA MAILING ADDRESS THE BOARD, COUNCIL, COMMISSION, AUTHORITY OR COMMITTEE ON P.O. BOX 181022 WHICH I SERVE IS A UNIT OF: -.-._-_..__._... ._.-..-_--- _ _--_-_-__-------._,_ _-.--------._-- CITY COUNTY M CITY L3 COUNTY LI OTHER LOCALAGENCY ----- ---- -- --- --.. -- - ------ j NAME OF POLITICAL SUBDIVISION: City of Casselberry CASSELBERRY SEMINOLE --.-----.---.----___-- E ON WHICH VOTE OCCURRED 4!1212023 MY POSITION IS: U ELECTIVE Cl APPOINTIVE This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee, It applies to members of advisory and non -advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before con-ipleting and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public: office MUST ABSTAIN frorn voting on a measure which would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on a measure which would inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent, subsidiary, or sibling organization of a principal by which he or she is retained); to the special private gain or loss of a relative; or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies (CRAs) under Sec- 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one -acre, one -vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in-law, and daughter-in-law. A "business associate" means any person or entity engaged in or carrying on a business enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (where the shares of the corporation are not listed on any national or regional stock exchange). M •. In addition to abstaining from voting in the situations described above, you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are- abstaining reabstaining from voting; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes. Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE: TAKEN: You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the. rninutes of the meeting, who will incorporate the form in the minutes. (Continued on page 2) CE FORM 8B - EFF. 11(2013 PA(;E 1 Adopted by reference in Rule 34-7.010(1)(f), F.A.C.