76 Deede Weithorn 02/03/2010 R5D_ ,
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' ~ ~ '. . - WHO MUST FILE FORM 8B ,..°. ~ . ~ ~ '
This form is for use by.any person serving_atthe county, city, or other local level of government on an appointed or elected board, council,
commission.,. authorit or.commitfee. It applies equally to members of advisory and non-advisory bodies who are ,.presented with a voting
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conflicf 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 wil~vary greatly depending
on whether you hold. an elective or appointive position. For' this reason", please pay close attention to .the instruction's on this form before -'
' completing the reverse side and fling the'form '; ~ '- , ' '
s -; : INSTRUCTIONS FOR`COMPLIANCE WITH~SECTI~ON 1'12.3143,_FL.ORIDA~STATUTES
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: A person holding elective or appointive county, mucncipal;°. oraother local 'public office MUST ABSTAIN from voting. on a measure which
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- . o his'or. her special private gain, orloss. Each elected. orappointed. local officer also is p~otibited from knowingly voting. on, a- mea-
Inures't ,
sure which inures to the special gain or, loss of`a principal (otherthan agovemment agency) by whom he orshe is retained (including the`
` • parent organization or subsidiary. of a corporate p~incipal,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 tusiriess associate. Commissioners of community redevelopment agencies under Seca 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'thaf '
"capacity:..:. . , ' : .
`For purposes of this taw; a "relative" .includes only-the officer's father, _mothe[, son,. daughter, husband, wife,. brother., sister, father-in-law,
mother in-law; son=in-taw, 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"lwhere the shares of the corporation,
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are not listed on any national or regional stock` exchange). ~ .
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.ELECTED OFFICERS ~ , , . _ ,
In addition to,abstaining from voting in3he 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 ahe. measure oh .which you...
,' 'are abstaining from voting; and' . .
~, WITHIN 15'DAYS9 FTER THE VOT POCCURS by completing and filing this form with the person responsible for recording the min-
utes of'the meetin who should incor orate the form in the minutes. -
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APPOINTED`OFFICERS: ~ ~ _ . .
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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~whethermade
by yqu 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:
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• You must complete and-file tFiis form (before .making any attempt to influence the decision) :with the person responsible #or recordingahe
minutes .of the-meeting, who will incorporate the form in the minutes..(Continued on other side) -
:~~ FO.RM:8B:~ M~EMIC~RANDUM OF VOTfNG ~CONFL'IC.;T F:OR
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,. COUNTY, MU~tVtCIPAL,~'AND OTHER`~LO.CAL PUBLfG OFFICEFRS~ ~'.
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LAST NAME-FIRST NAME-M DD NAME
NAME.O"r BOARD, COUNCIL, COMMIS
SION, AUTHORITY, OR COMMITTEE
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~ THE BOARD, COUNCIL', COMMISSION, AUTHORITY OR COMMITTEE ON
WHI E IS A UNIT. OF '
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l7 A.ITY O COUNTY ~ O OTHER LOCAL AGENCY -.
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CITY :
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' .NAME F OLITICAL SUBDIVISION.
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DATEON'WHICM VOTE OCCURRED '... ~ '° _-
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MY POSITION IS:
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.APPOINTED OFFICERS (continued) ~ '
• A copy of the form must 6e 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 ofyour conflict iri 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 bey provided immediately to the; other members of~the
agency, and the form must be read publicly at the riext meeting after the form is filed.
_ DISCLOSURE OF LOCAL OFFICER'S INTEREST
__________ ____~_____~___, hereby disclose that on ~~ b _ _~ __^ _
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(a) A measure came or will come before-my agency which (check one) ,
_ inured to niy special private gain or loss;
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_ inured to the special gain or loss of my business associate, _~~ ~' ~ ,r ~~~t~ ~~ ~ ~~`~~ ~..
inured to the special gain or loss of my relative, _`_ _ ~Gl~-,.
___ ' inured to the special gain o~ loss of______
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whom I am'retained; or
___ inured to the special gain or loss of ~ __ _______Y_~__~~__-__• 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 ih'the measure is as follows:
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ate 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:'
CE FORM 8B - EFF. 1/2000
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