83 Jerry Libbin 04/14/2010 R6A-7. _ ~~,,
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8B' MEMORANDUM 4F VOTING CONFLICT FO:R~ ,
F#ORM
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. ~COU~NTY, MUNICIPAL, AND OTHER LOCAL PUBLLC' O~'FICERS~
LAST NAME.-FIRST NAME=MEDDLE NAME
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G"'~ .~ NAME O'r BOARD, COUNCIL,"COMMISSION, AUTHORITY, OR COMMITTEE -
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MAILING ADDRESS -
" i ' // ~ ,THE BOARD, COUNCIL; COMMISSION; AUTHORITY OR COMMITTEE ON; '
WHIG I SERVE IS A UNIT.OF; ~ >
"" COUNTY -
` " '-T ~'~' ~ D COUNTY O~OTHER LOCAL AGENCY
CITY
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~~,~~~ ` .,OP~G~_ ~ r NAME OF POLITICAL SUBOIVI510N: ~ '
DATE ON WHICH VOTE CCURRED ~ MY POSITION IS:
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~ C8', ELECTIVE ' C7 APPOINTIVE
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WHO MUST -FILE 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,
.' commission;' authority; or:committee. It applies equally to members of advisory and non-advisory bodies who are'presented w'Ith a .voting
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confict of nfe~est under'Section.112.3143;'Florida Statutes.: ~ ~ •
Your, responsibilities underthe law when faced with voting on a measure in which you haves conflict of interest will vary greatly deperiding.
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on'whether:you hold' an;electi0e br`'appointiveposibon, For_ this reason, please pay .close attention to the instructions, on this form before
completing~the"reverse side and filing the forma
°_ INS.TRUCTIONS,FOR COMPLIANCE WITH, SECTION 112.31,43, FLORIDA STATUTES
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A pei-son`.holding elective,or appointive county,. municipal,:: or other local public office MUST ABSTAIN from voting on a measure which
•ihures~to his:or her special private gain.dr loss. Each elected or appointed local officeraiso is prohibited from knowingly voting'on a mea-
su~e,which imuresto the special gain, or loss'of a principal (other than a government agency)'by whom he or she 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 relative; or
to ihe. speciaf,pri'vate 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 special: tax districts elected on a one-acre, one-vote basis• are not prohibited from voting in that
capacity. • ., .-• .
Foc purposes of this law,:a "relative" includes only the officer's father, mother,_son,,daughter, hasband, wife, 'brother, sister, father-in-law,
' ,mother-in-law, son-iri-law, and daughter-in-law. A "business associate" means any person or entity engaged in or carrying on a business
enterprise with they officer a`s `a partner, joint venturer,. coowner of property, or cgrporate shareholder (where .the sharesJof the corporation .
are`nof listed on any national or regional stock exchange). ~ ~ •
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' ` .ELECTED OFFICERS: ~ - •
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In addition to~ abstaining from,"voting. in thesituations 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.vbting; and ~.` '
- WITHIN 1'5 DAYS AFTER THE VOTE OCCURS by completing arid filing this form with the person responsible for recording the min-
utes.ofethe meeting;-who should'inco~porate the form in the minutes.. i~
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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 .
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. by:you.or at your direction. ~ ~ - . ! - .
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IF YOU INTENIDTO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO,THE MEETING.AT WHICH THE VOTE WILLBE
TAKEN: . .
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•" 'You mustccomplete and file this'form.(before making any attempt to influence the decisiori) with the person responsible for recording the
:.minutes of the'meeting,°who will incorporate the form in the minutes: (Continued on other side) •
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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.
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: ` -
• You~must disclose'oraQy 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 nett meefinn aftp~ rtio t.,~.,, c~ E,i,:~, •
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DISCLOSURE OF LOCAL OFF.ICER'S INTEREST
I ~ - `7~~~/z L~ ~~! ~~ hereby disclose that on ~/ - /~ ~ ~"U •
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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 gaimor loss of my business associate, N-__ ~ . '
_ inured to the speciaF gain or loss of my relative, __ -_ .
_~ inured to the special gain or loss of__~1: i~r~.__~Pi¢-G~ C'd-~i7/,~~~ _~ - ~G~~~~. ~`___~_--___- , b
Y
whom I am retained; or _ .
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-_ inured 1o the special gain or loss of _ which
is the parentorganization 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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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.
Date Filed
CE FORM 8B - EFF. 1/2000
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