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FORM 813 MEMORANDUM OF VOTING CONFLICT FOR
<br />COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
<br />LAST NAME -FIRST NAME -MIDDLE NAME
<br />v s l S-
<br />NAME OF BOARD, COUNCIL, COMMIS N, AUTHORITY, OR COMMITTEE
<br />My) d I,
<br />MAILING ADDRE S
<br />801 a, C*4.O
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<br />THE BOARD, COUNCIL, COMMISSION, AUTHORITYOR OMMITTEE ON
<br />WHICH I SERVE IS A UNIT OF:
<br />El CITY (,COUNTY ❑ OTHER LOCAL AGENCY
<br />CIjY
<br />COUNTY,
<br />O n
<br />6DV W1 (\ `,1
<br />V
<br />NAME OF POLITICAL SUBDIVISION:
<br />DATE ON WHICH VOTE OCCURRED
<br />I
<br />MY POSITION IS:
<br />ELECTIVE ❑ APPOINTIVE
<br />WHO MUST FILE FORM 813
<br />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,
<br />commission, authority, or committee. It applies equally to members of advisory and non -advisory bodies who are presented with a voting
<br />conflict of interest under Section 112.3143, Florida Statutes.
<br />Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending
<br />on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before
<br />completing the reverse side and filing the form.
<br />INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
<br />A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which
<br />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-
<br />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
<br />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
<br />to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies under Sec. 163.356 or
<br />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
<br />capacity.
<br />For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law,
<br />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
<br />enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (where the shares of the corporation
<br />are not listed on any national or regional stock exchange).
<br />ELECTED OFFICERS:
<br />In addition to abstaining from voting in the situations described above, you must disclose the conflict:
<br />PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you
<br />are abstaining from voting; and
<br />WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the min-
<br />utes of the meeting, who should incorporate the form in the minutes.
<br />APPOINTED OFFICERS:
<br />Although you must abstain from voting in the situations described above, you otherwise may participate in these matters. However, you
<br />must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made
<br />by you or at your direction.
<br />IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
<br />TAKEN:
<br />• You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the
<br />minutes of the meeting, who will incorporate the form in the minutes. (Continued on other side)
<br />CE FORM 813 - EFF. 1/2000 PAGE 1
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