75 Matti Herrera Bower 12/9/09 R7G1i
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O~IVI^8~:. 1lIIEC3R~-NDI~~I t~F V~TIfVC~'C~NFLICI'-FOR
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C~:U.NTY, ~IV~~l1NICIhAL ~4ND°®TI-IE.6~ LaCa4L.'P~1BL1~'O~FI:CERS
LAST,NAME-FIRST NAME-M DDLE NAME ' ' ; ~ ~
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~ .NAME OF.BOARD, COUNCIL; COMMISSION,`AUTNORITY,
OR COMMITTEE
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MAILING ADDRESS c
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~ THE BOARD COUNCIL COMM `
^; f$SiON AUTHORfTY OR COMMfTTEE ON~ -
WHICH I SERVE I
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CITY ,' ~~ - COUNTY , .
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CITY ="` U COUNTY
` ^ OTHER~LOCAL AGENCY
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L ( NAME OF POLITICAL SUBDIVISION
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DATE ON WHICH VOTE.000URRED ~ ~ •'
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~ MY POSITIONiS - / " _
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' l~Y. ELECTIVE .
U APPOINTIVE -
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~~1NF10 MUSTfILE FORM 8B.-:
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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, ;
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commission; authority, or committee: It applies equally to members of advisory and non-a'dvisoryaiodies who:are;presenfed witti.,a voting<'
conflict of interest under Section 112.3143, Florida; Statutes'.- ~ `: ~ '
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.Your responsibilities under the law when-faced with votmg;;on a measure'iri which you. have a corflict of i
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epending ,
° on whetherryou",hold art elective or appointive position. For. this reason; please pay; close attentions to the instructions on this form before
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completing;the reverseside and fiing.ttie form.' °
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INSTRUCTIONS FOR COf1lIPLIANC . -
` ^ .. E''WITH SECTION 112:31,43; FLORIDA-STATUTES ~ •
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.~ '`A person holding elective or appoihtlve~eounty, municipal, or other local public office MUST ABSTAIN from voting on• a, measure which -
. inures to his or her special private .gain orloss:°Each elected or appointed local officer also is prohibited from knowingly voting on a-mea-' -'
' sure which.irures to the special gain or loss` of "a principal (other than,a goverriment,agen,cy) by whom..he or-she is,retained {including:.the
' ; pa~entbrganization or subsidiary.=offa corpor.'ate principal by vrhich he or`,she is`retained);'to the special-private"gain•or'loss of a relative; or
`: to the special private gain or loss,of,afbusiness associate. Commissioners of community;.redevelopment agencies under Sec. 163.356 or:
163.357 F S., and ,officers of independerit special taz dlstricfs elected, on a•one-acre ,one-vote. basis are not prohibited from voting~in~that-
.capacity .: ` . ;. ,, - , _
For purposes of Phis law a Yelative`°mcludes only,the officers father mother, son, daughter, husband,Fwife, brother, sister, father-in-law;,
-, mother In-law, son-in=law, and daughter In-.law A,:,business'associate '`means any person or entity engaged iri or carrying on a business
'.enterprise with the:-officer as a partner,°toint-venturer, coowner of property;~or cgrpdr'ate shareholder (where the.sharesofahe corporation
are not listed on.any-national 'or regionalstock'exchange)`.= ,
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ELECTEDOFFI'GERS -~ .~ `~. .~ .."
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°In addition to;abstaining`'from voting in the, situations described above, you-must disclose the conflict: ~ .
.' ' r ~ PRIOR TO THE VOTE"BEING TAKEN by pupNcly stat+ng to the assembly the nature of your rnterest rn the measure on which you
are atistalnmg from,votng; and.,,. ,~ ` ~ ,:
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WITHIN 15 DAYS AFTER THE~.yOTEr000URS bycompleting and filing this form withlthe person responsible for fiecording the min-
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utes ofithe meetmg;'wh`o should incorporate the form iri`the minutes. ,. ~ -
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= ~ APPOINTED.O~F)CERS: •:-° •
' Although you must abstain from votin"g in the situations described above; ,you otherwise may participate in these matters: However, ouY
must disctose,ahe nature of the conflict before making any attempt to„influence the decision,:whether•;orally or iri,wrifirig'and.whethermade " •
' by you~or`at=your. direction....:. ~. ~ ~ h
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IF YOU INTEND T,O.MAKE ANY ATTEMPTTO'INFLUENCE THE DECISION'PRIOR~TO THE MEETING AT WHIGH.THE VOTE' WILL BE ,
' ,TAKEN - A.
You must complete and~file thisform before makin an attem 4 to mfluerice the decision with the , ' '
' ( 9: y P ) person responsible for recording the
miriutes,of the,meeting,,who will incorporate the form~in the minutes. (Continued on other side) .. •
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'CE FORM`88"- EFF.~.1/2oDD - ,, ..
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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.
IFYOU 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. ~ ,
1i~ DISCLOSURE OF LOCAL OFFICER'S INTEREST
I._~~~1r>`1~~1_~~~~__~~~_____, hereby disclose that on_____j~. ~_ 20
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(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, __~~_~~tS'g~~_____
___ inured to the special gain or loss of_______ •
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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:
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Date Filed Signatur
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 8B - EFF. 1/2000 ~ PAGE 2