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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 /> DISCLOSURE OF LOCAL OFFICER'S INTEREST <br /> Fabiola Stuyvesant , hereby disclose that on 4(i' I 4)0 20 23 • <br /> (a)A measure came or will come before my agency which (check one or more) <br /> V 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 ,which <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 /> At the moment I was a Board Member of Alonzo and Tracy Mourning Senior High School Parent Teacher and <br /> Students Association. <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 /> 1512' 04)3QLjLuJ) <br /> Date Filed Signature <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 />