Laserfiche WebLink
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 /> I,A -e/ o4 ? /Q�C� , hereby disclose that on .�`--1dat'L 2 0 20 2. <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 as ociate, • <br /> 4'4- o o R o.v a,r 090 e 2 <br /> inured to the special gain or loss of my relative lc d-a 4 Co f l v <br /> inured to the special gain or loss of O�v `'v liJ 4 , by <br /> whom I am retained; or 6-0 40 ojes e t C�.Q j4' <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 /> 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 /> Date Filed Sure „ " <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 88-EFF 11/2013 PAGE 2 <br /> Adopted by reference in Rule 34-7.010(1)(f), FA C <br />