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I U FORM 813 MEMORANDUM OF VOTING CONFLICT FOR 2016 COUNTY, MUNICIPAL , AN ® OTHER LOCAL PUBLIC OFFICERS ST NAME-FIRST NAME-MIDDLE NAME NAME OF BOARD, COUNCI , COMMISSION, AUTHORITY, OR MMITTEE Gil iS 1 61 'rC c/Z ' Yr M MAILING ADDRESS _ THE BOARD , COUNCIL, COMMISSIO AUTHORITY OR COMMITTEE ON 8 VV, I SERVE IS A UNIT OF: Ulit El COUNTY ❑ OTHER LOCAL AGENCY COUNTY c\4WO ` NAME\ILL 1) `F POLITICAL SUBDIVISION : DATE ON WHICH VOTE OCCURRED MY POSITION IS : ELECTIVE ❑ APPOINTIVE WHO MUST FILE FORM 88 This form-,is for use by any person serving at the county , city , or other local level of government on an appointed or elected board , council , commission , authority , or committee . It applies equally to members of advisory and non-advisory bodies who are presented with a voting conflict of interest under Section 112 . 3143 , Florida Statutes . Your responsibilities under the. . law"when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position . For this reason , please pay close attention to the instructions on this form before completing the reverse side and filing the form . INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112 . 3143 , FLORIDA STATUTES A person holding elective or appointive county , municipal , or other local public office MUST ABSTAIN from voting on a measure which inures to his or her special private gain or loss . Each elected or appointed local officer also is prohibited from knowingly voting on a mea- sure which inures to the special gain or loss of a principal (other than a government agency ) by whom he or she is retained ( including the parent organization or subsidiary of a corporate principal by which he or she is retained ) ; to the special private gain or loss of a relative ; or to the special private gain or loss of a business associate . Commissioners of community redevelopment agencies under Sec. 163 . 356 or 163 . 357 , F . S . , and officers of independent special tax districts elected on a one-acre , one -vote basis are not prohibited from voting in that capacity . For purposes of this law , a " relative " includes only the officer's father, mother, son , daughter, husband , wife , brother, sister, father-in -law , mother-in-law , son-in- law , and daughter-in-law . A " business associate" means any person or entity engaged in or carrying on a business enterprise with the officer as a partner, joint venturer, coowner of property , or corporate shareholder (where the shares of the corporation are not listed on any national or regional stock exchange) . • ELECTED OFFICERS : In addition to abstaining from voting in the situations described above , you must disclose the conflict: PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting ; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the min- utes of the meeting , who should incorporate the form in the minutes . • APPOINTED OFFICERS : Although you must abstain from voting in the situations described above , you otherwise may participate in these matters . However, you must disclose the nature of the conflict before making any attempt to influence the decision , whether orally or in writing and whether made by you or at your direction . IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE TAKEN : • You must complete and file this form ( before making any attempt to influence the decision ) with the person responsible for recording the minutes of the meeting , who will incorporate the form in the minutes . (Continued on other side ) PAGE 1 CE FORM 8B - EFF . 1 /2000