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APR 10 190 <br />BOOKfru 865 <br />IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION OR VOTE AT THE MEETING: <br />• You should disclose orally the nature of your conflict in the measure before participating. <br />• You should complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes <br />of the meeting, who should incorporate the form in the minutes. <br />DISCLOSURE OF STATE OFFICER'S INTEREST <br />hereby disclose that on <br />19 7Q <br />(a) A measure came or will come before my agency which (check one) <br />inured to my special private gain; or <br />inured to the special gain of <br />, by whom 1 am retained. <br />(b) The measure before my agency and the nature of my interest in the measure is as follows: <br />/ /-c / 6. . <br />f <br />Date Filed <br />Signature <br />NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317 (1985), A FAILURE TO MAKE ANY REQUIRED <br />DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: <br />IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN <br />SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000. <br />The Board reviewed memo and map as follows: <br />76 <br />