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rYOU <br /> ED OFFICERS (continued) <br /> the form must be provided immediately to the other members of the agency. <br /> must be read publicly at the next meeting after the form is filed . <br /> E 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 THE <br /> 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 <br /> Fmeasure <br /> Davis hereby disclose that on March 14 20 O-� <br /> or will come before my agency which (check one) <br /> pecial 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 /> by <br /> _ inured to the special gain or loss of <br /> whom I am retained, or <br /> , which <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 /> March 14 , 2006 <br /> Signature <br /> Date Filed <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 /> PAGE 2 <br /> CE FORM 813 - EFF. 1 /2000 <br />