5/4/1983 - Laserfiche WebLink

Home Browse Search

BoaR w FORM 4 MEMORANDUM OF VOTING CONFLICT LAST NAME — FIRST NAME — MIDDLE NAME AGENCY is unitof: DATE ON WHICH VOTE OCCURRED SCIJRLOCK, -TR May 4, 1983 MAILING ADDRESS DON r ❑STATE NAME OF PERSON RECORDING MINUTES 2138 20th Avenue 131COUNTY Virginia Hargreaves CITY 2IP COUNTY TMDal5ERtrerVORDING MINUTES Ver _ B h-Indian❑MUNICIPALITY �++ yy 1��11 1C NAME OF AGENCY SPECIFY Board of County Commissioners ❑OTHER 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: Awarding of Bid on irregation system 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: Manager of Irregation Ccmpany i i 3. Person or principal to whom the special gain described above will inure: ia.0 Yourself b.@ Principal by whom you are retained: William Jordan Sprinkler System CO. (NAME) SIGNATURE DATE ON WHICH FORM 4 WAS FILED WITH THE PERSON RESPONSIBLE FOR RECORDING MINUTES OF THE MEETING AT WHICH THE VOTE OCCURRED: May 4, 1983 MA 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 §112.917 (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 08.000. CE FORM 4 - REV. 12-79 78