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i <br /> 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 MAKENO' 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 /> v I, wPR1 S _ n ?vis , hereby disclose that on . June 18 20 13 <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, brnt hAA ; Rs-i .4:1 �rnrr a <br /> _ inured to the special gain or loss of , by <br /> whom 1 am retained, or <br /> inured to the special gain or loss of A 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 , borther , owns and . operabes a business and may ., or may not <br /> benefit from-_the _ _de.cision . <br /> Date Filed A 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 OR1 t SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A <br /> CIVIL P1 . ENALTY NOT TO EXCEED $10,000. <br /> GE FORM 88 - EFF* 1/2000 , PAGE 2 <br />