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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 /> C,,� �IDISCLOSURE OF LOCAL OFFICER'S INTEREST <br /> I, (/O z i G f �C. Q LL_ , hereby disclose that on Ts)f E MJ J. 1 }5 ,20 ey. : <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 nature of my conflicting interest in the measure is as follows: <br /> aNvt. (ccLos6-t -- <br /> ictG Lktk.e._ 6:0 ,c) kr)4.e_ 714%--cr‘ecg <br /> cl,vS U2L it ofk,/ <br /> DuAk accok--P _ Likkts Nvat- vars <br /> tzji /zo <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. 1/2000 PAGE 2 <br />