81 Jerry Libbin 04/14/2010 C7A,~~
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.. . ' ;WHO MUST FILE FORM 8B ...:. - , ,
= This,form is for use by; any person serving et the county, city, or ottier'local level of government ori. an',appointed or elected board,council,
commission,'. authority, gr.committee.-It applies equally to members.of advisory and nori-advisory bodies who are presented with:a voting
conflict of interest under Section 112.3143,,Florida Statutes.
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Your responsibilities. under the law when'faced with•woting on a measure in which you have a conflict of interest will vary greatly depending
on;whether,you hold an elective or appoiritiJe position. For this reason, please'pay,close attention to the,:instruotions oh this form before'
completing the reverse side and filing the form.. , . , .
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~- INSTRUCTIONS.FOR'COMPLIANGE WITH SECTION 112:31.43,•:FLORIDA STATUTES ",•~:
A "erson holdin 'elective. or a ` ~ '
p g ppomtive county,;murticipal, or.oth'er.aocaLpublic office MUST ABSTAIN from-voting`on a measure which
. inures to his`or her special private gain or~loss.. 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 she is retained (including .the'
,parerit organization or. 'subsidiary of a corporate principal by which'he orshe is retained); to the special private gain or loss of a relative; 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~independent specal'tax districts elected on aone-acre, one-vote basis are .not prohibited from voting in that
capacity.. _ ~ .
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For ur oses of this-{aw, a •
" p p "relative" includes only the officer's father, mother, son,:daughter;,husband, wife, brother, sister,-father-in-law,
mother-in-law; son-in-taw, and-.daughter-in-raw. A "business associate". means ariy 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 .(where the shares of the corporation
are not listed: on ,ahy national or regional: stock exchange): ~ ~ •
ELECTED OFFICERS: . ~ ~ - ~ •
In addition toabstaining from votrrig.in the situatrons,described,atiove, you must disclose the conflict: ~ '
PRIOR TO=THE VOTE -BEING TAKEN by publicly statirig to the assembly the nature-of your. interest in the measure on, which you `
are~atistainingfirom;votng; and-. ': '. •
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" ' WITHIN 15 DAYS AFTER,THE VOTE.OCCURS by completing and filing this.form'with the person 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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AlthougFi 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 attemptto influence the decision, whether orally or in writing and whether made
by you oraf your direction.. .. - _
IF~YOU INTEND TO MAKE ANY ATTEMPTTO_-NFLUENCETHE`DECISION PRIOR TO THE MEETING AT'WHICH~THE VOTE WILL BE
TAKEN: `.;,
..You must complete and file This form (before making any attempt to~influence~the decision) with the persori responsible for recording the
: annutes of the meeting, v/ho wilLincorporate the form in the: minutes. (Continued "on other side) ' ~ ~'
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' F~4RM 8B 'MEMORANDUM. OF VOTING. CONFLICT'FO'R`
~CGU~NTY; MUNICIPAL, AND OTHER.LOCAL PU.BLIC~OFFICERS
LAST NAME-FIRST NAME-M'DDLE NAME ~ • ' NAME OF BOARD, COUNCIL', COMMISSION, AUTHORITY, OR COMMfTTEE
s. a
MAILING ADDRESS ~
' / THE BOARD, COUNCIL, COMMISSION, AUTHORITY OR COMMITTEE ON
WHICH' FSERVE IS A UNIT OF:
" ~ COUNTY 'CITY U COUNTY ^-0THER, LOCAL AGENCY
CITY
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NAME OF POLITICAL SUBDIVISION.'
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VOTE OCCUR ED ~
DATE ON WHICH
C _ Q MY POSITION IS: '
"` ELECTIVE a U APPOINTIVE
APPf~INTED 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 INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: ~ ,
• You must-disclosa oraNy 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 fo 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 `~- ~ ~~ ~
(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 loss of my relative, ;_ ~•
_` inured to the special gain or toss of_ ~ b
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whom I am retained; or •
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___ inured to the special gain or loss of __ ___ _ __ ____, which
is4he parent organization. orsubsidiary of a principal which has retained me.
(b) The measure before my agency ahd_the nature of my conflicting interest ih the measure is as follows: -.
~' Y .Q-6e~C y Uhf r~ Po ~ . ~7 rrr,7/ ~~l,,;y_T,, ~ ,,, f ~ . ~~ ~2 c , ', •
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Date Filed . _ - "
NOTICE: UNDER ~PROVtSIONS ~F 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 1N SALARY, REPRIMAND, OR A
CIVIL'PENALTY NOT TO EXCEED $10,000.
CE FORM BB - EFF. 1/2000 ~ ~ ~ PAGE 2•