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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 />DISCLOSURE OF LOCAL OFFICER'S INTEREST q <br />I, b()Tt Prk) S, 4��,LC1kP , hereby disclose that on c /17 , 20 <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 />9 111-) log <br />Date Filed Si ature <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 />