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55 Neisen Kasdin 4/18/01 R7C P;P(J FORM 88 MEMORANDUM OF VOTING CONFLICT FO COUNTY, MUNICIPAL, AND OTHER lOCAL PUBLIC OFFICERS ~HI)lH r .'i,\.\.IF ~I s0\J '6l2.Q)/J Av. """~ OARU. cou;'S] ~'~"";JSlo'. Alii HORIlY OR "OM" , nEE I HE HOAR!). COlJ.-';CII.. CQ.\l.\;tISSION, ALilHORITY OR COMMITTEE ON WHICH I SERVE IS;\ lINIrQF .\1.-\11 1....(; .\I>OKfSS CIIY CI1Y o COUNTY o Q1HER 10C"1 A(;E:-.CY COt.; ,'IlTY "'\1M I~;;;'-;'U.oe;~~ t+ M V res ITION IS: lJ.\ leO' \\ HlCH \'()J E O('(TRIU:t> ELECTIVE 0 APPOI....Tl.. E WHO MUST FILE FORM 88 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. Ie applies equally to members of advisory and non.~d.....isory bodies who are presented with a voting contlict of interest under Section 112.3143, Florida Statutes. Your, :sponsibilities under the law when faced with a measure in which you have a contlict of interest will varv greatly depending on whether you hold an elecdve or appointive position. For this reason, please pay close attention to the instr~ctions on this form before completing the reverse side and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES ELECTED OFFICERS: A person holding elective county, municipal, or other local public office MUST ABSTAIN from voting on a measure which inures to his special private gain. Each local officer also is prohibited from knowingly voting on a measure which inures to the special gain of a principal (other than a government agency) by whom he is retained. I n either case, you should disclose the contlict: 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 WITHIN 15 DAYS AFTER THE VOTE OCCURS ~y completing and filing this form with the person responsible for recording the minutes of the meeting, who should incorporate the form in the minutes. APPOINTED OFFICERS: A person holding appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which inures to his special private gain. Each local officer also is prohibited from knowingly voting on a measure which inures to the special gain of a principal (other than a government agency) by whom he is retained. . :\ person holding an appointive local office otherwise may partic;ipate in a mauu in which he has a connict of inter.est,'but must disclose the nature of the connict before making any auempr to influence the decision by oral or written communication; whether :nade by the officer or at his direction. iF YOU INTEND TO :VIAKE ANY ATTE:VIPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH fHE VOTE WILL BE TAKEN: . You should complele and file this form (before making any attempt to intluence the decision) with the person responsible for recording the minutes of the meeting, who will incorporate the form in the minutes. , A copy of the form should be provided immediately to the other members of the agency. , The form should be read publicly at the meeting prior to consideration of the matter in which you have a contlict of interest. PAGE I I ')R.\.l .'(8.1.91 , I , IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: . You should disclose orally the nature of your connict in the measure before participating. . You should complete the form and file it within 15 days after the vote occurs with the person responsible {or recording the minutes of rhe meeting, who should incorporate the form in the minutes. I, ~~l~€N ~pgnlr-\ DISCLOSURE OF LOCAL OFFICER'S INTEREST A-gil L \ ~ , hereby disclose that on 2..Ct:J J .~: (a) A measure came or will come before my agency which (check one) - inured [0 my special private gain; or U V inured to the special gain o{ 1"~Q QQk ( 'Pili\~~ , by whom I am relained. (b) The measure before my agency ~ 7~nOr: ~ ~:tr~~in :e :\~:~e ::i-s:~;~;tW) (vJ Vh7 &l~+) ()I/\ fA>{\. \A\'\ VQ U.wt 1'l101kv'. te Filed ~ J~ /01 ~ Signature TICE: UNDER PROVISIONS OF FLORIDA STATUTES ~1I2.317 (1985). A FAILlJRE TO MAKE ANY REQUIRED CLOSURE CONSTITUTES GROUNDS FOR AND MAYBE PUNISHED BY ONE OR MORE OF THE FOLLOWING: 'EACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN .ARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000. , HB.I<91 PACE ~ I \.