78 Michael Góngora 03/10/2010 R7E®.
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. . F'~ORM .8B : NIE1101O:RANDUM OF VOTLNG CONFLICT FOR
. C0=U~NT,Y, MUNICIPAL, AND OTHER LOCAL PUBLIC OF'FfCERS
LASTNAME-FIRST NAME-M LE ME
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' THE BOARD, COUNCIL, COMMISSId ,AUTHORITY OR COMMITTEE ON '
WHICH I SERVE IS A UNIT OF: ..
COUNTY .
- TY U COUNTY
I - - ^ OTHER LOCAL AGENCY
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~ ~ - NA E F POLITIC SUBDIVISION:
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VOTE OCCURRED
DATE•ON WHICN
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MY.POSITION IS: ~,
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.3 .-- ~- i ELECTIVE U APPOINTIVE:
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: s -WHO MUST~FILE FORM;8B ; ~ .. ~ .
This form is for use by any person. serving at the county, city, or other local level of government on an appointed or elecled board; council,
commission;~authority; or.:coi-nmittee. tt applies equally .to members of advisory and non-advisory bodies who aye presented with a voting
conflict of interesYunder Section 112.3143;Florida;Statutes.:
Your^responsibilties 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 ol-'appointive position.- For'this reason, please pay close attention to the instructions on.ttiis form"before
competing the reverse)sideand filing the.form. _
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. ~-INSTRUCTIONS FOR COMPLIANCE-WITH SECTION ~112.31,43,`FLORIDA STATUTES
A person holding elective orappointive county, municipal; br other local public office MUST, ABSTAIN from voting on a measure which
' inures.to his. nor hers ecial rivate . aih or loss. Each elected or appointed local officer also is prohibited from knowingly voting on a mea-•
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:sure which inures to .the. speclal,gain or loss of a principal (other than a government agency) by whom he or she. is retained (including the
parent organisation or subsidiary of a corporate principal by which he or she is retained);,to the special private gain or loss of-a relative; or
' to the speciaf.private gain;or loss ;ofa business associate. Commissioners:of community redevelopment agencies under Sec. 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 that.
,capacity. ~ ~. ;•. . ,
For'purposes.of this law, a "relative" includes only the-officer's. father,;mother, son, daughter, husband, wife, brother,, sister, father-ih-law,
. mother-in-law, son=in<law, and daughter-in-law. A "business associate" .means any person or entity engagedJin or carrying. on a busihess
enterprise with the officer as a partner, joint venturer, coowner of property, orcgrporate shareholder (where the shares of the corporation
are not hstedrori any national or regional.stock:exchange). '; ,
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`ELECTED OFFICERS: ~ -' ~ •
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'_ In addition 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 the measure on which you
'are.abstaining~from voting; and r. `
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. WITHIN 15 DAY$ AFTER THE VOTE OCCURS by completing and filing-this form with the person responsible for recording the min-
utes ofthe'meeting;~who should,,incorporateahe'form in the minutes: ' .` ,
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. AP~'OINTED::OFFICERS:, ~ '. ` `. ~,', .: ~ ~.: " '
Althtough you'must abstain from voting in 'the situations described'above,.you otherwise may participate in ,these matters. 'However, you
mustdisclose 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 l"O INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
TAKEN:. ~ - L
' You musYcomplete and file this form .(before making; any attempt to'influence the decision) with the person responsible for 'recording the
minutes of the meetin who will ' co t th f ~ th t
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g, rn rpora e e orm rn a menu es. (Continued on other side) ~ .
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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 of your 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 ih 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:
DISCLOSURE OF LOCAL OFFICER'S INTEREST
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_ _~?_`~~____-___, hereby disclose that on_ ~~~ (:~ _, 20 ~~~:
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(a) Ameasure came or will come before my agericy which (check one)
inured fo my special private gain or loss; ~ ,
±/ -inured. to the specia{ gain or loss of my business associate, __~.~ ,
-_ inured to the special gain or toss of my relative, _~_
inured to the special gain or loss of___
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.whom l em retained; or
-_ inured to the special gain or loss of _ -
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is the parent organizatioh or subsidiary of a principal which has retained me: ••
(b} The measure•.before my agency and the nature of my conflicting interest in th'e measure is as follows: `~
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Rate Filed
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NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317., A FAILURE TO MAKE~ANY REQUIRED?DISCLOSURE
CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED SY ONE OR MORE'OF THE FOLLOWING: IMPEACHMENT, ~.
REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT; DEMOTION, REDUCTION 1N SALARY, REPRIMAND, OR A
CIVIL PENALTY` NOT TO EXCEED $10,000.
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