Form 8B Ed Tobin - (68)~ ... ... .. ~S
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WHO MUST FILE FORM 86
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 atlvisory 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 tiling 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 olTicer 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 pnncipal by which he or she is retained); to the special private gain or loss o(a relative; or
to the special private gain or loss of a business associate. Commissioners of community retlevelopment agencies under Sec. 163.356 or
163.357, F.S., and officers of independent special lax districts elected on a one-acre, one-vote basis are not prohibited from voting in that
capacity.
For purposes of this law, a -relativri includes Only me officer's father, mother, son, tlaughter, husband, wife, brother, sister, father-in-law,
mother-in-law, son-in-law, and daughter-in-law. A "business assocate" 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 adtlition 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 me 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 msponsible for recording the min-
uteS of the meeting, who shoultl incorporate the form in the minutes.
APPOINTED OFFICERS:
Although yov must abstain from voting in the situations describetl 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) _ _
APPOINTED OFFICERS (continued)
• A copy of the form must be provitletl 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 EXCEP7 BY DISCUSSION AT THE MEETING:
• You must disclose orelly the nature of your conflict in the measure before parliapating.
• You must complete the form and file Il within 75 days after the vote occurs with the person responsible far recording the minutes o1 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 publicy at the next meeting after the form is filed.
G/' DISCLOSURE OF LOCAL OFFICER'S INTEREST
I• '^ ~ ~/ O ~~~ ~J __ ,hereby disclose that on ' .~
(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 to the special gain or loss of my relative.
Inured to the special gain or loss of C L (; ,
-- -----------------~----~- y
whom I am retained; or
___ inuretl to the special gain or Toss of ______ ________ __ __-_, which
is the parent organization or subsidrary 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:
~'". ~ y' 6 ~ ~~
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Date Filed -------------------------------
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.
CE FORM 88 - EFF. 1!20(10
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