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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 : • You must disclose orally the nature of your 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 ^� Wes l ey S . Davi s hereby disclose that on Aril 1 9 April , 20 (a ) A measure came or will come before my agency which (check one ) inured to my special private gain or loss; X inured to the special gain or loss of my business associate , inured to the special gain or loss of my relative , ! inured to the special gain or loss of _ by whom I am retained ; or inured to the special gain or loss of which 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 : April 19 , 2005 Date Filed gna ure ^ NOTICE : UNDER PROVISIONS OF FLORIDA STATUTES § 112 . 317, 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 $ 10 , 000 . RECEIVED AT IRC-BCC MEETING CE FORM SB - EFF. 12000 PAGE 2 DATE/ 1/ ITEM # 1lTTT TTS 1 !9T TT T/