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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 . i DISCLOSURE OF LOCAL OFFICER 'S INTEREST 11 Wesley S . Davis hereby disclose that on March 1 , 20 1 1 ( 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 , brother , Brian Davis- inured avisinured 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 : Relative , Brian Davis , brother , owns and operates a septic tank business and may or may not benefit from the decision . March 1 , 2 01 1 Date Filed §rgnature Wesley S . Davi s 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 . CE FORM 813 - EFF . 1 /2000 PAGE 2