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FORM 4 MEMORANDUM OF VOTING CONFLICT LAST NAME — FIRST NAME — MIDDLE NAME AGENCY is unit of: DATE ON WHICH VOTE OCCURRED Patrick B Lyons ❑STATEJuly 7- 2 MAILING ADDRESS NAME OF IPERSON RECORDING MINUTES 17 Sailfish Road 'COUNTY Janice Caldwell CITY ZIP COUNTY TITLE OF PERSON RECORDING MINUTES Vero Beach, FL 32960 Indian River ❑MUNICIPALITY Recording Secretary NAME OF AGENCY SPECIFY Board of County Commissioners ❑OTHER of Indian River Countv _ Florida MEMORANDUM OF CONFLICT OF INTEREST INA VOTING SITUATION [Required by Florida Statutes §112.3143(1979) ] If you have voted in your official capacity upon any measure in which you had a personal, private, or professional interest which inures to your special private gain or the special private gain of any principal by whom you are retained, please disclose the nature of your interest below. 1. Description of the matter upon which you voted in your official capacity: North Beach Water Franchis-e 2. Description of the personal, private, or professional interest you have in the above matter which inures to your special private gain or the special private gain of any principal by whom you are retained: i Have a deposit on a dwelling in the area that would be j served by franchise. I� 3. Person or principal to whom the special gain described above will inure: a.09 Yourself b.❑ Principal by whom you are retained: NCM e I (NAME) SIGNATURE Z DATE ON WHICH FORM 4 WAS FILED WITH THE PERSON RESPONSIBLE FOR RECORDING MINUTES OF THE MEETING AT WHICH THE VOTE OCCURRED: I LZ Ju -1-y 12, 198 FILING INSTRUCTIONS This memorandum must be filed within fifteen (15) days following the meeting during which the voting conflict occurred with the person responsible for recording the minutes of the meeting, who shall incorporate the memorandum in the meeting minutes. This form need not be filed merely to indicate the absence of a voting conflict. Florida law permits but does not require you to abstain from voting when a conflict of interest arises; if you vote, however, the conflict must be disclosed pursuant to the requirements described above. NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES § 112.817 (1979), 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 $5,000. CE FORM 4 - REV. 12-79 J U L 7 198227 Qo�c 50, ?Aa 147.1