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JUN 29 1992 <br />lli� <br />BOOK 86 FN.uI 6' <br />IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: <br />• You must disclose orally the nature of your conflict in the measure before participating. ' <br />• You must complete the form and�file it within IS days after the vote occurs with the person responsible for recording the minutes of <br />the meeting. who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other <br />members of the agency, and the forth must be read publicly at the next meeting after the form is filed. <br />DISCLOSURE OF LOCAL OFFICER'S INTEREST <br />I, __ non r_ -Scurlock- 0 r , hereby disclose that on June 29 199 2 <br />(a) A measure came or will come before my agency which (check one) Potentia 1 1 y <br />X X inured to my special private gain; <br />inured to the special gain of my business associate, <br />inured to the special gain of my relative, <br />inured to the special gain of by <br />whom I am retained; or <br />inured to the special gain of , which <br />is the parent organization or subsidiary of a principal which has retained me. <br />(b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: <br />A proposed settlement of a lawsuit. <br />The County Commission is a defendant, and I am also an <br />individual defendant against whom the County has a cross <br />claim for indemnification and attorney's fees.. <br />Board approval., of the settlement potentially inures to my <br />benefit, in -that it'may give rise to a claim for reimbursement. <br />of my individual attorney's fees and costs, under F.S. 111.07. <br />Jena -29, 1999 �r►• L <br />Date Filed Signature <br />NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317 (1991), 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 S5;000. ' <br />_E FORM 8B-10.91 <br />w <br />Fps <br />PAGE 2 <br />