84 Michael Góngora 04/14/2010 R6A-7..
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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 with a voting
conflict~of interesf under Sectlonu1.1'2:3143, ..Florida Statutes:: ~ .
.Your. responsibilities under the. law when fieced with voting on 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-this form before
' completirig~the reverseside ahd~filing.the-form. . _ ~ ~ '
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:INSTRUCTIONS ,FOR COMPLIANCE WITH SECTION! 112.3143, FLORIDA STATUTES
- A person. holding elective o~ appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which .
inures to~his!or her special pivate gain or loss. Each.elected or.appointed .local officer also is prohibited from knowingly voting.on a mea-
sure which,;inures~ to ttie special gars orloss of aprincipal (other than a government agency) by whom he or she is retained (including the
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parent organization or subsidiary of a corporate principal by which he or she is'retained); to the special .private gain onloss of 'a-relative; or
to the special private gain or"loss of a busing"ss associate. Commissioners of comriwnity 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
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capacity.
For".purposes of'this -law,, a. "relative" includes only the officer's father, mother; son, daughter, husband, wife,. brother,' sister, father-in-law,
mother-in-law, son::-in-law, and daughter-in-law. A "business as-sociate" means any pei•son~or entity engaged in or carrying on=a business
.enterprise with the officer a's a partner joint,ven4urer, coowner of property, or cgrporate shareholder (where. the shares of..the corporation
are not listed on' any national nr regional stock exchange). ~ - •+
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ELECTED OFFLCERS: ' , - . ~ , - -
Ih 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 '
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'`>WITHIN 15 DAYS AFTER THE VOTE OCCURS by compteting and filing this form with the .person responsible for recording the min-.
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ufes of, the meeting, who should incorporate the form in the minutes: i ,
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APPOINTED:OFFICERS~ .. .
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Although you must abstain fr•orrt 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 vrhether made
byyouu. 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 ~ ,. ~ .
• You mustcornplete and file this form (before-making any attempt to influence the decision) with the .person responsible for'recording the
. minutes of the meeting, who. will incorporate the-form ihthe minutes. {Continued on other side) '
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' ~ CONFLICT FOR ~ "
FORM ~8B- ~ 'MEMORANDUM QF VOTI
-COUNTY, MUNICIPAL, AND OTHER-LOCAL PUBLIC OFFICERS
LAST NAME-FIRST NAME 'D LE NAME
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MAILING ADD S
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THE,BOARD, COUNCIL, COMMISSION, F1U
WHIC ERVE IS A UNIT OF: ' „ ORITY OR COMMITTEE ON'
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COUNTY CITY cJ 000NIy
D OTHER LOCAL AGENCY
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CITY
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~~ G+11/1 I ~ NAME O~ L TICAL SUBDIVISIO +:
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DATEO WHICH VOTE OCCURRED
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MY POSITION S:,
ELECTIVE .. []. APPOINTIVE
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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. ~ z
iF YOU MAKE NO.ATTEMPT TO INFLUENCE THE DECISION'EXCEPT BY DISCUSSION AT THE MEETING: .
• `You must disclose orally 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 responsibie for recording the minutes of the :~
meeting, who.must incorporate the form in the minutes. A`copy of the form must tie provided immediately to the other members of.the "
agency, and the form must be. read publicly at the nett meeting. after the form is filed.
DISCLOSURE OF LOCAL OFFICER'S INTEREST
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_____~___, hereby disclose that on___1~~'I ~„~ ___1 `1"t__ 20 LC) `,
(a) A measure came or will come before my agency which (check one) t ~ ,
i red to my special private gain or loss;
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_~ inured to the speciai gain or loss of my business associate .. ~'
~_ inured to the~special gain or loss of my relative, _~ _ ~ -
-; _~ inured to the special gain, or loss of_ ~ y
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whom I am, retained; or .
___ 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 ., 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 86 - EFF. 1/2000 ~ PAGE 2~