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APPOINTED OFFICERS ( continued ) A copy of the form must be provided immediately to the other members of the agency. • The form must be read publicly at the next meeting after the form is filed . IF YOU MAKE NO ATTEMPT -TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING : _ Y_au-must disclose orally-the nature-of- _our-conflict-in-the-measure_before_participating . - -- —•— • 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 meeting , who must incorporate the form in the minutes . A copy of the form must be provided immediately to the other members of the agency , and the form must be read publicly at the next meeting after the form is filed . DISCLOSURE OF LOCAL OFFICER' S INTEREST I Wesley. S Davis hereby disclose that on SeDtemb 22 20 Oq--' ( a) A measure came or will come before my agency which (check one) inured to my special private gain or loss ; inured to the special gain or loss of my business associate , X inured to the special gain or loss of my relative , by inured to the special gain or loss of whom I am retained ; or which _ inured to the special gain or loss of is the parent organization or subsidiary of a principal which has . retained me. (b) The measure before my agency and the nature of my conflicting interest in the measure is as follows : Rel: Ati . ve , Brian Davis , brother , owns a sa.ndiimine and may or may not benefit from the decision . September 22 2009 Date Filed Signature FREMOVAL ER PROVISIONS OF FLORIDA STATUTES § 112 . 317 , A FAILURE TO MAKE ANY REQUIRED DISCLOSURE BE PUNISHED BY ONE OR MORE OF TH S GROUNDS FOR AND MAY OFFICE OR EMPLOYMENT , DEMOTION , REDUCTION NSALARY , EPRIMAND , OR A SUSPENSION FROMY NOT TO EXCEED $ 10 , 000 . PAGE 2 CE FORM 86 - EFF . 112000