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APPOINTED OFFICERS ( continued ) • A copy of the form must be provided immediately to the other members of the agency . • The form must be read publicly at the next meeting after the form is filed . IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING : • You must disclose orally the nature of your conflict in the measure before participating . • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the meeting , who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other member : of the agency , and the form must be read publicly at the next meeting after the form is filed . DISCLOSURE OF LOCAL OFFICER' S INTEREST I , Tim Zorc hereby disclose that on junp 1 1 th 20 13 (a) A measure came or will come before my agency which (check one ) X inured to my special private gain . or loss; inured to the special gain or loss of my business associate , inured to the special gain or loss of my relative , — inured to the special gain or loss of — by whom I am retained ; or _ inured to the special gain or loss of which is the parent organization or subsidiary of a principal which has retained me . (b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: I am currently involved in Litigation that in part involves the claim of ownership on numerous single family home sits in Indian River County that have pre-paid impact fees . ,lune 11 , 2013 natur Date Filed Si g NOTICE : UNDER PROVISIONS OF FLORIDA STATUTES § 112. 317 , A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING : IMPEACHMENT , REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION , REDUCTION IN SALARY , REPRIMAND , OR A CIVIL PENALTY NOT TO EXCEED $ 101000 . CE FORM 813 - EFF. 12000 PAGE