Form 8B Ed Tobin - (69)~~
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FORM 8B MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
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CITr OOUNTr -- _Cltt _ OCOUVIY JOTnER IOCn;. nrEN_CY
NArdt (h- PQ i 'CA- SUBDIV IaON
OP,TE ON WHICH VOTE OCGURREUI>• C~ L1Y POSITION IS
,__ - ___~~~~ ~~1~'~C~ ~ELECTNE ~-U apvOINTIVE
WHO MUST FILE FORM 86
This form is for use by any person serving al the county, city. or other local level of government on an appointed or elected board, council,
commission, authonly, or committee. It applies equally to members of advisory and non-advisory bodies who are presented with a voting i
conflict of interest under Section 1123143, Florida Statutes.
Your responsibilities under the 'aw when faced with voting un a measure in which you have a contticl of interest will vary greatly depending
on whether you hold an elechvc 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 yovemment 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
t0 the special private gain or loss of a business associate. Commissioners of community redevelopment agenaes under Sec. 163.356 or
163.357, F.S., and officers of independent special lax districts elected on a one-acre, one-vole basis are not prohibited from voting in that
capacity.
For purp05es of this law, a "relative" includes only the officer's father, rnolher, son, daughter, husband, wile, brother, sister, father-in-law,
mother-in-law, son-in-law, and daughter-in !aw. 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 7HE VOTE BEING TAKEN by p::bllc!y stating to the assemb'y the nature of your interest in the measure on which you
are abstaining from voting; and
WITHIN 75 CAYS AFTER THE VOTE OCCURS by Completing and liliny this form with the person responsible (or recording the min-
utes of the meeting, who should incorporate the (ono 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 confictt before making any attempt to influence ilia decision, whether orally or in wnhng 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)
CE FORM 86 - EFF. 119000 CAGE t
C` ~ ("
APPOINTED OFFICERS (continued)
• A copy of the form must be provided immedia?ely to the other members of fhe agency.
• Thr. form must De mad publicly al the aexl meeting after the form is fled.
IF YOU 0.1AKE NU ATTEMPT TO INFLUENCE THE DEGSION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose era0y thn naturn. of your conOicLn the measure before participating.
• You must cnmpletn the form and life it wi0nn 15 days after the vote occurs with the person responsible for recording the minutes of the
meeting, who must ~ncorpomle the form in the minutes. A copy of the Form must be provided immediately to the other members of the
agency, and the (orrn must be read publicly at the next rneebng att¢r the form is filed.
~~y ^,~ DiSCl!,,(LO''SURE OF LOCAL OFFICER'S INTEREST (( ~j ~
h__________ ~_. ---1-La ~~-jr%S~___. ,hereby disclose that on.. ____.1 _'~' •~ -_5.~__--• 20 "t?:
~'_ _
(a) A measure came or will come before my agency which (check one)
___ inured to my special privato gain o+ loss;
__ inured to the special gain or Inns or my business associate, ______ _____________ -- _ ;
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__ inured to the special gain or loss of my relative, ____________. ____________
_ _ inured to me special gain cr loss of_ ______________ ___________ y
---------- ---------- - -- --~ b
whom I am retained; of
__ inured to the special gain or loss of _____ ________________ . ____ ___________, which
is the parent organization or subsidiary o(a principal which has retained me.
(b) a measure before my agency and the nature of my congiding interest in the measure is as folbws:
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G1;r `~~,c- ACS-~ t 5 +`~`_/~ ~ ~ ~ ~$
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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