HomeMy WebLinkAbout09091997aIF YOU MAKE NO'ATTEMPT TO.INFLUENCE THE DECISION EXCEPT BY DISCUSSION OR VOTE AT THE MEETING:
Yoti should disclose orally the nature of your conflict in the m~'asure before participating.
You should complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minut~
of the.me,ting, Who should' incorporate the form in the minutes.
Dff, OLO~JI~ OF STATE OFI:ICEI~$ INTEREST
I. qe.r~tcl ~... 5'm'C'L ,~ r. .. ~,e.,by di~lose ,h., on "~:.... fi
(a) A measure came or will come before my agency which (check one)
P/inured to my special private gain; or
inured to the slx, cial gain of
, by whom I am retained.
(b) The measure before my agency and. the nature of my interest in the measure is as follows:
Date Filed
NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317 (1985), A FAILURE TO MAKE ANY REQUIRED
DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING:
IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN
SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000.
CE FORM 8B- IO.86 PAGE 2