74 Michael Góngora 12/9/09 R7C, .
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' HO MUST FILE"Ft~RM~8B
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This form is for use by any.personaserving ~a't the county city or other local level of government on an appointed or,elected board,. council, i ; •
. ` , coiimmission,-authority, or committee: It applies. equally to'members of°advisory and` non-advisory.'bodies•wlio are; presented with°a:voting
' conflict of!interest under Section Y12.3143.Florida'Statutes: `~ - .
Your responsibilities under the law when faced with`voting on a rrieasure in which you have~a conflict of interest will'vary greatly',depending '.
• on'whether..you;,hold an electlve.or.appointiye position. For this,7eason,,please payrclose attention to the; instructions on this form before
completing+the reverse sitle;andFfiling the form . ; ' ,, •.. ~' -¢ -
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°'~' - '~IIVSTRUCTIONS rFOR COMPLIANCE WITFI SECTION 1112:3143, FLORIDA STATUTES~_°`
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. A:person holding>electiye or appointive county, munlcrpal,`.or,other local public.office'MUST ABSTAIN from.,voting on a measure which .
. inures to his or her special prvate gain orioss. Each elected or-aPpoinfed local~officeralso.is prohfbited~fi-om knowingly voting~on a mea-:
sure which inures to"the special gain`or~loss, of a principah{otherahan aagovernment~agency) by-whom he or she is refained.(including the
paren~'or`ganization,or subsidiary of a corporate p~incipal.by which fie or.she. is'retained); Eo.the special.piivate gain'br'loss~of a''elative; or
~to the special private gain'o~ loss of a business associate. Commissioners. of commurnty~redevelopment.agencies'under Sec.`i163.356 _or .
~. -163.357 ,~F.S;~and.officers!of independent spiecial iax districts~elecfed on:a~one-,acre, one=vote basis are riot profiitiiYed from voting in.that , `
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capacity , ~ ~ ~ ~_ ..
For purposes of this law, a ''relative' includes only,the officers father, mother song daughter, husband, wife, brother, sister, father-rn-law,
timother in-law son in-law, and daughter in;law: A '+business associate means any person"br entity engaged in or carrying, on:.a`tiusiaess
enterprise with the: officer a's a partner~'joint, venturer; coowner of,property, oi' corporate shareholder `(where the shares of the-corporation
are not listed on any national or regional stock exchange): "` ~ ~ '
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ELECTED OFFICERS . ~ ~ ~ • . , _ ~ `
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' In adcJition to°absfaining-from~,votingin the situations described above yourriust disclose theconflict:'
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PRIOR TO THE VOTE t3EING'TAKEN by publicly stating to the :assembly the nature of your interest in the` measure on which you .
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..•are,abstaining"from'voting; and ', ;; ':
WITHIN;15 DAYS AFTER THE`VOTE,000URS by completing and filing this.form with
the person
' a v responsible for recording the min-
`~utes of the meeting,.,who-should incorporate the form: in` the' minutes. - ;~" "'~ -
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`.APPOINTED OFFICERS , :.:.', ~ ,
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Although you rnust'abstain frorri.voting iii'-the situations described above ,you othervvise may participate in these~mattecs..However,~you
rriust disclose, the nature of the conflict before making any'attempt• to'influen~ce the: decision,.whether orally or in writirig and whethec'made' - '
by you or at your direction. w ;, ; . >. ~ ~. .
IF YOU INTEND TO MAKE ANY-ATTEMP~ ~ - ~ ;.
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^ ~ TTO INFLUENCE THE DECISIQN PRIORITO THE MEETING AT'•WHICH THE VOTE WILL BE~
TAKEN .'. - -
You must,cornplete,and file this'form (before making ariy attempt to influence the decision) with the person responsible for recording the
~minute§ of the meeting, who will incorporate the form in the minutes.: "(Continued~on other sidef
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,~ ' - FORM 8~-.~ ~VlEnii(~RAIVC-lJ~ ~~~V~T~I~1G"C~IVFLIC~f ~®R," .-~ "
C~l1NTY,~:IViU6V;ICI.Pi~L~,:~?-(VD OT~1-IER~LO~C/~L PU~LI:C O~~IC'E~RS
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LAST NAME 'FIRST NAME-M.DDLE NAME ~ ' ,
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//' i NAME OF BOARD, COUNCIL, COMtiAISSION, AUTHORITY, OR COMMITTEE
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MAILING AD SS ~ ''
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1'~JO.•,~- r.~" ~~.~~1` THE BO RD COUNCIL COMMt O_ '
A ,. SSiO AUTHORITY: R CpMMiTTEE ON' '
WHICH~.BERVEISAUNITOF'.~.- -
CIT
Y
.'` COUNTY ITY ~ CJ COUNTY ~ OTHER LOCAL AGENCY -
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. . NAME O UB • IVISION
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DATE
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ON WHICH VOTE OCCURRED
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MY POSiTION'iS _
T E ; U , _APPOINT.IVE"
APPOINTED' OFFICERS (continued)
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• A copy of the form must be provided immediately to the other members ofythe agency.
• The form must be read-publicly at the next meeting after=ttie form is filed. , 1
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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 itwithin 15 days after the vote;occurs'with the persoh responsible•for recordirig tiie.:miriutes of the
.meeting, who must incorporate the, form in the minutes. A copy of theaform 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
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I'-~~~~-~--~`~~--~t~'=''------~herebydisclose that on_-!_---------~---------------~20 ~_~:
(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 {oss of my relative, ______________________________
___ inured~to the special gain or loss of_________________________
whom I am retained; or
___ inured to the special gain or loss of ________
is the parent organization or subsidiary of a principal which has retained me.
, by
which
(b) The measure before my agency and the hature of my conflicting interest in the measure is as follows:_
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~- ~ yv. ~w~e tL C~; 2~"~G ~ o f ~~~ M ~, ~Ltrl ~.. ~ Seer ~
l-e~~ c~~-ee,N.~.-E- ~ c,~ ~n -tom.. G~-~ e.~ ~cc.~ ~e~zc~L,.
1 X1,,0,, ~., ~.j (nc~ ~ v10 1 Pia , G~ ~ ~, i c~' ~ ,-~ ~ o ~'i~~ ~ ; „a
C ~ c. v~Y ~Gn Ge
Date Filed -
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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. '
CE FORM 86 - EFF. 112000 PAGE 2