53 Simon Cruz 2/2/101 R7A
:2.1 2a:J1- R. 7 A
FORM 88 MEMORANDUM OF VOTING CO FLlCT FOR
COUNTY, MUNICIPAL, AND OTHER lOCAL PUBLIC OFFICERS
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'^d7 HOARO~1h (OM;J[~ ;;;r"V. OR (OMMtl1H
I HE HOr\RO, COUNCIl.. COMMISSION, AUTHORITY OR COMMITTEE ON
Wt lCH I SERVE IS ^ tlNlrOF
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a COU NTY
a OlHER lOCAL AGENCY
C'QU:'IlTY
NAME Of-"lQl.lTIC^l SUIIDIVISION:
MY POSITION IS:
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ELEC"TIVE
o APPOl:'llTIVE
WHO MUST FILE FORM sa
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 contlict of interest under Section 112.3143, Florida Statutes.
Your,osponsibilities under the law when faced with a measure in which you have a contlict 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 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.
In either case, you should 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
WITHIN 15 DAYS AFTER THE VOTE OCCURS ~y cumpleting 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. .
A person holding an appointive local office otherwise may participate in a matter in which he has a contlict of interest, but must
disclose the nature of the contlict before making any attempt to intluence the decision by oral or written communication, whether
made by the officer or at his direction.
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH
THE VOTE WILL BE TAKEN:
. You should complete and file this form (before making any attempt to intluence the decision) with the per@ponSblefor
recording the minutes of the meeting. who will incorporate the form in the minutes. 6 2>
. 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 conflict of interest.
: FORM MB .141
PAGE 1.
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IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
. You should disclose orally lhe nature of your conflicl in the measure before participating.
. You should complete the form and file it within 15 days afler lhe vOle occurs with the person responsible for recording the minutes
of the meeting, who should incorporate lhe form in the minutes.
/I DISCLOSURE OF LOCAL OFFICER'S INTEREST
SIfJ10Jl L.-/211:t- , hereby disclose that on 'le6rtlJIIL'/ ~ /
,~l:
I.
(a) A measure came or will come before my agency which (check one)
_ inured to my special private gain; or
_ inured 10 the special gain of
, by whom I am retained.
(b) The measure before my agency and the nature of my interest in the measure is as follows:
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S,gnature
)ate Filed
lonCE: UNDER PROVISIONS OF FLORIDA STATUTES ~112.317 (l9g5). A FAILURE TO MAKE ANY REQUIRED
'ISCLOSURE CONSTITUTES GROUNDS FOR AND MA Y BE PUNISHED BY ONE OR MORE OF THE FOLLOWING:
Y1PEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION. REDUCTION IN
-\LARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000.
RMHB-I-91
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