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Fr- 'I AUG U 1989 BOOK 7 7 F'Ar. -RM 8B , MEMORANDUM OF VOTING CONFLICT FOR C LINTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS) LAST N AiL•-I IRST NA\I -:+11D LE NAME % f NAMiE OF OARD. COUNCIL, COMMISSION, AUTHORITY, R COMMITTED /, , / %� (.ACX( AC1 �fL��'� ltC.(w> IG�cLcGt� t'L%1. MAILING ADDRESS CME v �Cr� ��T �"' e��Z Q BOARD. COUNCIL, COMMISSION, AUTHORI Y. OR COMMITTEE ON IS A WHICH CITY I SERVECOUNTYNIT Q OTHER LOCAL AGENCY OUN'rY e&K • C CITYM06 NAME OF POL TICAL SUBDIVISION: (' ` DATE ON WHICH VOTE OC ' RR . MY POSITION IS: k ELECTIVE '. APPOINTIVE WHO MUST FILE FORM 811 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. The requirements of this law are mandatory; although the use of this particular form is not required by law, you are encouraged to use it in making the disclosure required by law. Your responsibilities under the law'when faced with 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 close attention to the instructions on this form before completing the reverse side and filing the form. - INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3943, FLORIDA STATUTES ELECTED OFFICERS: A person holding elective county, municipal, or other local public office MUST ABSTAIN from voting on a measure which inures to his special private gain. Each local officer also is prohibited from knowingly voting on a measure which inures to the special gain of a principal (other than a government agency) by whom tie is retained. In either case, you should 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; wird WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and tiling this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes. APPOINTED OFFICERS: A person holding appointive county, municipal, or other local public office ;\-MUST ABSTAIN from voting on a measure which inures to his special private gain. Each local officer also is prohibited from knowingly voting on a measure which inures to the special gain of a principal (other than a government agency) by whom he is retained. A person holding an appointive local office otherwise may participate in a matter in which he has a conflict of interest, but must disclose the nature of the conflict before making any attempt to influence the decision by oral or written communication, whether made by the officer or at his direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE (MEETING AT WHICH THE VOTE WILL BE TAKEN: • You should 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. • A copy of the form should be provided immediately to the other members of the agency. • The form should be read publicly at the meeting prior to consideration of the matter in which you have a conflict of interest. 11..u.. r.. 14 s � � PA(iF I