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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 /> DISCLOSURE OF LOCAL OFFICER 'S INTEREST <br /> I , Wesley S . Davis , hereby disclose that on Ortnhpr 2R r . 20 _(17—: <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, hrnt hpr , Rr i a n na v i s <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 /> Relative Brian Davis , brother , owns a sand mine and may or may not benefit <br /> from the decision . <br /> /D 46 l 7 <br /> Date Filed signature Wesley S . Davis <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 813 - EFF. 1/2000 PAGE 2 <br />