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gII13 13" A . 9 - 10 C= ORM 813 MEMORANDUM OF VOTING CONFLICT FOR COUNTY MUNICIPAL AND OTHER LOCAL PUBLIC OFFICERS LAST NAME-FIRST NAME-MIDDLE NAME NAME OF BOARD, COUNCIL, COMMISSION, AUTHORITY, OR COMMITTEE MAILING ADDRESS THE BOARD, COUNCIL, COMMISSION, AUTHORITY OR COMMITTEE ON WHICH I SERVE IS A UNIT OF: CITY COUNTY ❑ CITY 2 COUNTY ❑ OTHER LOCAL AGENCY Vero Beach Indian River NAME OF POLITICAL SUBDIVISION MONO q10 DATE ON WHICH VOTE OCCURRED MY POSITION IS: Une 11 2013 X) ELECTIVE ❑ APPOINTIVE WHO MUST FILE FORM 86 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 dose 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 . 3571 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 ). • A- k ♦ i R f f f f R f f R f • 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- Liles 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 'r0 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 ) CE FORM 83 - EFF . 1 /2000 PAGE 1