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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 the minutes of <br /> 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 the <br /> agency, and the form must be read publicly at the next meeting after the form is filed . <br /> DISCLOSURE OF LOCAL OFFICER'S INTEREST <br /> I Tim Zorc A hereby disclose that on March 19 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 , <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 /> i <br /> 1 was the beneficiary of a small portion of the proceeds check to Vocelle & Berg <br /> Attorneys listed on the warrants and wires on the March 19th Board of County <br /> Commission agenda . <br /> The payment was from business activities where I was an authorized agent of a <br /> company that entered into an agreement with a client in early 2012 <br /> - -- ---- . ! <br /> T � <br /> Date led Sig <br /> •NOTICE: " UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A . FA .LURE 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. 112000 PAGE 2 <br />