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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 /> • The form must 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 <br /> the minutes 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 <br /> of the <br /> DISCLOSURE OF LOCAL OFFICER ' S INTEREST <br /> Wesley S . Davis hereby disclose that on November 8 20 1 1 <br /> (a) A measure came or will come before my agency which (check one) <br /> inured to my special private gain or loss ; <br /> XX inured to the special gain or loss of my business associate , Rick Baker <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 /> November 8 , 2011 <br /> Date Filed Signature Wesley Davis <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 $ 10 , 000 . <br /> CE FORM 813 - EFF. 1 /2000 a PAGE 2 <br />