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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 /> ��DIIS�CLOSURE OF LOCAL OFFICER'S INTEREST <br /> I, ( 7t9Z(.s9f .. mod °' u-- ,hereby disclose that on l ,20 147 <br /> (a)A measure came or will come before my agency which(check one) <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 ,which <br /> is the parent organization or subsidiary of a principal which has retained me. <br /> (b)The measure before my agency and the natu of my conflicting int • the measure is as follows: <br /> .04,1 QL—C_ \=2. e_4-e■ <br /> ro w L4)(A,\GIB (k,03./e- a.& 1,A.k-e-c r <br /> c g ledAETeCS Sao <br /> lk <br /> Le{ e -idLL D k� L _ <br /> � <br /> lq« l4- <br /> Date Filed 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.1/2000 PAGE 2 <br />