HomeMy WebLinkAbout2010-174 I U
FORM 813 MEMORANDUM OF VOTING CONFLICT FOR
2016
COUNTY, MUNICIPAL , AN ® OTHER LOCAL PUBLIC OFFICERS
ST NAME-FIRST NAME-MIDDLE NAME NAME OF BOARD, COUNCI , COMMISSION, AUTHORITY, OR MMITTEE
Gil iS 1
61 'rC c/Z ' Yr M
MAILING ADDRESS _ THE BOARD , COUNCIL, COMMISSIO AUTHORITY OR COMMITTEE ON
8
VV,
I SERVE IS A UNIT OF:
Ulit El COUNTY ❑ OTHER LOCAL AGENCY
COUNTY
c\4WO ` NAME\ILL 1) `F POLITICAL SUBDIVISION :
DATE ON WHICH VOTE OCCURRED MY POSITION IS :
ELECTIVE ❑ APPOINTIVE
WHO MUST FILE FORM 88
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 .
Your responsibilities under the. . law"when faced with voting on 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 . 3143 , FLORIDA STATUTES
A person holding elective or appointive county , municipal , or other local public office MUST ABSTAIN from voting on a
measure which
inures to his or her special private gain or loss . Each elected or appointed local officer also is prohibited from knowingly
voting on a mea-
sure which inures to the special gain or loss of a principal (other than a government agency ) by whom he or she is retained
( including the
parent organization or subsidiary of a corporate principal by which he or she is retained ) ; to the special private gain or loss
of a relative ; or
to the special private gain or loss of a business associate . Commissioners of community redevelopment agencies under Sec. 163 . 356
or
163 . 357 , F . S . , and officers of independent special tax districts elected on a one-acre , one -vote basis are not prohibited
from voting in that
capacity .
For purposes of this law , a " relative " includes only the officer's father, mother, son , daughter, husband , wife , brother,
sister, father-in -law ,
mother-in-law , son-in- law , and daughter-in-law . A " business associate" means any person or entity engaged in or carrying on
a business
enterprise with the officer as a partner, joint venturer, coowner of property , or corporate shareholder (where the shares of the
corporation
are not listed on any national or regional stock exchange) .
•
ELECTED OFFICERS :
In addition to abstaining from voting in the situations described above , you must 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 ; and
WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the min-
utes of the meeting , who should incorporate the form in the minutes .
•
APPOINTED OFFICERS :
Although you must abstain from voting in the situations described above , you otherwise may participate in these matters .
However, you
must disclose the nature of the conflict before making any attempt to influence the decision , whether orally or in writing and whether
made
by you or at your direction .
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
TAKEN :
• You must 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 . (Continued on other side )
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D
APPOINTED OFFICERS ( continued )
• A copy of the form must be provided immediately to the other members of the agency .
• The form must be read publicly at the next meeting after the form is filed .
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING :
• You must disclose orally the nature of your conflict in the measure before participating .
• You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes
of the
meeting , who must incorporate the form in the minutes . A copy of the form must be provided immediately to the other members of the
agency , and the form must be read publicly at the next meeting after the form is filed .
DISCLOSURE OF LOCAL OFFICER' S (INTEREST
J 1 hereby disclose that on ) 1 �1 V .� 20 JQ
( a ) A measure came or will come before my agency which (check one)
inured to my special private gain or loss ;
_ inured to the special gain or loss of my business associate ,
inured fo the special gain or loss of my relative ,
inured to the special gain or loss of by
whom I am retained ; or
inured to the special gain or loss of which
is the parent organization or subsidiary of a principal which has retained me.
(b ) The measure before my agency and the nature of my conflicting interest in the measure is as follows :
Date Filed Signature
NOTICE : UNDER PROVISIONS OF FLORIDA STATUTES § 112 . 317 , 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 $ 10 , 000 .
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