30 Neisen Kasdin 11/4/98 R7D
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FORM 88 MEMORANDUM OF VOTING CONF ICT FOR
COUNTY, MUNICIPAL, AND OTHER lOCAL PUBLIC OFFICERS
N,\......e Ot' HOARD. COU:\iOI.. CQMMISSIO.'-. AU I HORIT)'. OR COMMITTEE
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I tiE HOARD. COUNCil.. COM,\-lISSION. AUTHORITY OR COMMITIEE ON
'''filCH I SERvE IS A tJ:'Ill r OF
~lY 0 COUNTY 0 OTHER IOC~1 A(;E:'IiCY
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:'oIAME 0..' POliTICAl. SUIIDIV1S1Q,\,:
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MY POSITION IS:
~E(lI"'E
o APPQI\,T/VE
WHO MUST FlU FORM 88
This form is for use by any person serving at the county; city, Or other local.level of govern'lnenc 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 incerest under Section 112,3143, Florida 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 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 councy, 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 contliet:
PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly Ihe nature of your incerest in the measure on
which you are abstaining from voting; and
WITHIN 15 DAYS AFTER THE VOTE OCCURS Ijy 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,
A person holding an appoi'ntive local office Olherwise may participate in a maner in which he has a cannicr of interest, but must
disclose the nature of the canniet before making any auempt to innuence the decision by oral or wriuen 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 allempt to innuerlce the decision) with the perso@Yr,"blefor
recording the minutes of the meeting, who will incorporate the form in the minutes, ~ 0
. 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 maller in which you have a contlict of interest,
P.-\G.E.I
..OR....'H8.1.91
IF YOU MAKE NO AITEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
. 'You should disclose orally lhe nalure of your conflicr in rhe measure before participaling, ,
. You should complererhe form and file ir wilhin 15 days afrer lhe ,'ore occurs wirh lhe person responsible for recording lhe minures
of rhe meering. who should incorporale rhe form in rhe minules,
I, .NE=-I s;e),LILM D uJ
PISCLOSURE OF LOCAL OFFICERJS}NTEREST
, hereby disclose Ihat on J / If
.
,19 '18 :
(a) A measure came or will come before my agency which (check one)
_ inured to my special privale gain; or
V inured 10 Ihe special gain of T ~l..JaMutJ.DO Nt!f'MOrzt::-
. by whom I am rerained,
(b) The measure before my agency and the nalure of my inreresr in lhe measure is as follows:
No A~+v.i0.... (1otJfL1G+ - .Du~ 10 ~TATeD InWf:;--:s-J-
{)J: ~()NV / Ib'1J::.'Y1AurJDO ~ 17TL..5Jy(c+ SiL{ -
~~ )ed- DF RFP r T811 all)
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Signature
,OTICE: UNDER PROVISIONS OF FLORIDA STATUTES ~II2,317 (1985), A FAILURE TO MAKE ANY REQUIRED
JISCLOSURE CONSTITUTES GROUNDS FOR AND MA Y BE PUNISHED BY ONE OR MORE OF THE FOLLOWING:
\,fPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT. DEMOTION, REDUCTION IN
ALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED S5,OOO,
)RMU.I-91
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