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<br /># <br /> <br />,/ <br /> <br />APPOINTED OFFICERS (continued) <br /> <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 /> <br />. You must disclose orally the nature of your conflict in the measure before participating. <br /> <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 /> <br />DISCLOSURE OF LOCAL OFFICER'S INTEREST <br /> <br />I, f\J II RY'<\~ S 'S(:)CZ L c....u.ip ,hereby disclose that on <br /> <br />1/1110'2 <br />I <br /> <br />,20_: <br /> <br />(a) A measure came or will come before my agency which (check one) <br />JL'" 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 <br />whom I am retained; or <br /> <br />, by <br /> <br />inured to the special gain or loss of <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 /> <br />, which <br /> <br />r.~ O\.lfN)/\ <br /> <br />a---r... <br /> <br />~~~ <br /> <br />~~~/ <br /> <br />SigJ~ture I I <br /> <br />/ <br /> <br />NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES 9112.317, ~ 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 /> <br />Date Filed <br /> <br />.7 11 I ) D<~ <br />I I <br /> <br />CE FORM 88 - EFF. 1/2000 <br /> <br />PAGE 2 <br />