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FORM 88 MEMORANDUM OF VOTING CONFLICT FOR
COUNrf, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
LA"'l;L fiRST NAME ~~~L::;:E U ,UL NAME O~ ~i~I~IUI~'j (OO;rN. ~THORITY. OR:~OMMITTEE
~IAILING ADURESS THE BOARD. COUrlf."Il.. COMMISSION. AUTHORITY, OR COMMITTEE ON
4 -d--.O;JI . \!tv WHIt'H I SERVE IS A UNIT Of:
..s . \:? 1'- .: 1L ~ ON IX CITY . . COUNTY . . OTHER LOCAC AGENCY
("ITY COUNTY
Yi I f.><W1.\ f?:>w r+- NAME OF POLITICAL SUBOIVISION: w--
DATE ON w ICH VA E o<'TURRED I F1~t1 g61-\-C
I \ 2 <'1 00 MV POSITION IS: ELECTIVE APPOINTIVE
WHO MUST flU FORM II
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. II applies equally to members of advisory and non-advisory bodies who are presented
with a IIOling conflict of interest under Section 112.3143, Rorida Statutes. .
Your responsibilities under the law when faced with a measure in which you have a conflict of interest will vary greatly depending
on whether you hold an elective or appointive position. For lhis reason, please pay close attention to the instructions on this form
before completing the reverse side and tiling lhe form,
INSTRUCTIONS FOR COMPUANCE WITH SECTION 112.3143, FLORIDA STATUTES
ELECTED OFFICERS:
A person holding elective county, municipal, or olher 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 tD 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 by completing and liIing this form with Ihe person responsible for recording
the minutes of the meeting, who should incorporale the form in the minules.
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 yoting 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 mailer in which h" has ~ confli;;t oi interest, but must
disclose the nature of the conflict before making any attempt to influence the decision by ora. or wriHen commLnication, whether
made by the officer or at his direction.
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE \IEETING AT WHICH
THE VOTE WILL BE TAKEN:
,
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. You should complete and liIe this form (before making any attempt to influence the decision) with me ~
recording the minutes of the meeting, who will incorporate the form in the minutes.
. A copy of the form should be provided immediately to lhe other members of the agency.
The form should be read publicly at the meeting prior to consideration of lhe mailer in which )'ou have
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION
AT THE MEETING:
· You should disclose orally the nature of YOUf cannier in the measure before participating.
. You should complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minules
of Ihe meeting, who should incorporale Ihe form in the minutes.
I, ~C2-ISO~ ~N
DISCLOSU~E OF LOCAL OFFICER'S I~Rm
, hereby disclose that aD II ')- q
,~oO:
(a) A measure came or will come before my agency which (check one)
_ inured 10 my special private ~
~nured to Ihe special gain of .
<l~M
, by whom I am retained.
(b) The measure before my agency and the nalure of my inlerest in Ihe measure is as follows:
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Signature
NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES ~1I2.317 (1985), A FAILURE TO MAKE ANY REQUIRED
DISCLOSURE CONSTITUTES GROUNDS FOR AND MAYBE 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 S5,000.
FORM 88 . '0-86
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