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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 /> ti• ` , Tha, forl'n 'Irriust 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 <br /> 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 <br /> the <br /> DISCLOSURE OF LOCAL OFFICER 'S INTEREST <br /> I , Wesley S . Davis hereby disclose that on May 17 , 20 , 1 1 <br /> ( a) A measure came or will come before my agency which (check one ) <br /> C <br /> tired to my special private gain or loss ; �+ <br /> ed to the special gain or loss of my business associate , <br /> inured to the special gain or loss of my relative, <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 /> _ May. _ 1 7 , 2011 <br /> Date Filed Signature <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 $ 109000 . <br /> CE FORM 813 - EFF. 1 /2000 1 . b PAGE 2 <br />