79 Jerry Libbin 03/10/10 R7E- -. ( ~, .
.~~ •F=ORM 8B - MEIIIIORANDUM OF VOTING CONFLICT FOR. ~~'
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•~ ;COdJ~NTY, MUNICIPAL, •AND OTHER ~LO-CAL ;PUBLIC. OFFICERS
• LAST NAME-FIRSSNAME-M'DDLE NAME NAME OF BOARD; COUNCIL-; COMMISSION, AUTHORITY, OR COMMITTEE ''
MAILING ADDRESS .~ _ ~ ' '- THE BOARD, COUNCIL, COMMISSION„AUTHORITY.OR COMMITTEE ON
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WHI~~C''H I SERVE IS A UNIT OF `
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COUNTY ~
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O O LOCAL•AGENCY
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.CITY
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NAME OF POLITICAL SUBDIVISION:
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DATE,,ON WHICH VOTE OCCURRED.. ~
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MY POSITION IS: /'
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', ELECTIVE U APPOINTIVE
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m~ .._ WHO MUST FILE FORM 8B' :: .. :, , . - . ~.
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This form istifor use•by:any person serving at the county, city; or.other. local level of~government on an •appointed or elected board, council,
cornmisslon; authority, or committee. It applies equally to members of advisory and non-advisory bodies who are presented with a voting
conflict of interest, under Section '112.3143,Florida Statutes, ; , ...•
" Your responsibilities'undertke IaWwtien faced with voting om 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 flits form before
' ` completing-the reverse sideand filing the form. " ~ -
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INSTRUCTIONS FOR COMPLIANCE WITH SECTION 1.1,2.3143, .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 hisor her`•special private gain orfoss., Each elected or appointed local officer 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 he,:is retained' (including the
parent organization or subsidiary, of a•corporate principal'by which, he.or she is retained); to'the special private gain or loss of a reli3tive; or
to~the special private gain or loss of a business associate: Commissioners of community redevelopment agencies under'Sec. 163.356 or
163.357, F:S., and officers of independentspecial tax districts elected on a one-acre, one-vote: basis -are not prohibited, from voting in that
.capacity. ' { ,m .:
Fol- purposes of 'this law a "'relatives' includes only fhe `officer's father, another; son,,daughter, husbanij; wife,~brother, sister, father-in-law,'
•mother-in-law, son-in-law, and daughter-in-law. A."business associate".means any person o~~entity engaged~in,or carrying on a business
enterprise with. the officer as a, partner,:joint venturer, coowner of property, or cgrporate shareholder (where the shares of the corporation
are not listed. on any national or regional stock exchange).: ~ '
ELECTED OFFICERS: ~ ~ ~ ~ .
In addition to abstaining: from voting .in the situations described above, you.must disclose the conflict: • "
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PRIOR TO THE VOTE BEING TAKEN by .publicly sta#ing to the assembly the nature of your interest in'the measure on which you
. • .are atistairting°from voting;,and '•
WITHIN,15 DAYS AFTER THE VOTE OCCURS by completing acid filing this form with the person responsible for recording the min-'
utes ofrthe meeting; •whoAshould incorporate 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 othe-vvise-may, participate. in these, matters. However,. you
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must disclose the nature of the conflictbefore making any attempt to influence,the decision, whether orally or in writing and whether made
by~you or.at your direction:- ~ •
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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 rnust: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 wii6 incorporate the form in.the minutes. -(Continued on otherside)
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~~ POfIVTED 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.
IF YOU MAKE NO ATTEMPT TO,I'NFLUENCETHE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose orally the nature of your coriflictin the measure before participating.
You must complete the form and file it within 15 days afterthe vote occurs with the,,persori responsible for recording the minutes of~the.
meeting,. who must incorporate the•form iri the minutes. A copy of the form must be provided immediately to the other members of the
agency, and the form must be read pubiiclyat the next meeting after the form is filed..
DISCLOSURE OF LOCAL OFFICER'S INTEREST ~ '
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I ~ - ~ -~2~-~ -~ P `~ ~'_%'`~ _ hereby disclose that on ___ /U
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(a) Ameasure came or wiH 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, __~ ~A~~~EA~ ~~,~'~_- .~
____ inured to the special gain orloss of my relative, ~_
_~ inured to the special gain orloss of_____ -.
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whom I am retained; or -y •
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-_ 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
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NOTICE: UNDER PROVISIONS•OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE
CONSTITUTES GROUNDS F.OR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT,•
REMOVAL OR•SUSPENSION FROM OFFICE OR€MPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A '
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CIVIL PENALTY NOT TO EXCEED $10,000. ~ ';
CE FORM 8B - EFF. 1/2000 PAGE 2