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CA <br /> IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION OR VOTE AT THE MEETING: <br /> • You should disclose orally the nature of your conflict in the measure before participating. <br /> • You'should complete the form and file it within I S days after the vote occurs with the person responsible for recording the minutes <br /> of the meeting, who should incorporate the form in the minutes. <br /> .• _ • <br /> T A DISCLOSURE OF STATE OFFICER'S''IINTEREST I q. •, <br /> • C�vtroissl0aev ,Vag^,'J in--S hereby disclose that on lOt-sn �'2-- , 19 ie <br /> (a) A measure came or will come before my agency which (check one) . <br />-- — inured to my special private gain; or <br /> / FfPtrv(ic•�OT <br /> ✓inured to the tspecial gain of 7h P SAryp �` i/R, ��.47. • T'-'�'fryoiJHAdi , by whom l am retained. <br /> (b) The measure before my agency and the nature of my interest in the measure is as follows: <br /> U+„) Calvo0A S 5‘ i ftcr •+- a^ - • 8-.4. <br /> f/t�//v n•e 7/Pe evade of r . <br /> ! /�G57i4tt� {fMt VoinA'r� - o Et 7 11 r5 /55v e' <br /> /Az hr (*.CT r_/...e.e-e/Alee,0-% <br /> Date Filed / Signature !/ <br /> NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317 (1985), A FAILURE TO MAKE ANY REQUIRE. <br /> DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWINC <br /> IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION. REDUCTION t <br /> SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED 55,000. <br /> P/ �I <br /> CE FORM BB - laar, <br />