14 David Dermer 11/19/97 R5C
11/19!f7- !:sc
FORM 88 MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
'AST NAME H.S' 'AM" "M'':J>f NAME
NAME OF HOARD. COUNCil., COMMISSION. A.UTHORITY. OR COMMI1TEE
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cITY C COUNTY C OTHER LOCAL AGENCY
NAME OF POI.ITICAl SUBDIVISION:
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MY mONIS:...........
'-tii ELECTIVE C APPOINTIVE
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 eleeted 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 interest 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. .
INSTR~CTlONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
ELECTED OFFICERS:
A person holding elective county, municipal, or other local public office MUSf ABSfAIN 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 IS DAYS AFrER THE VOTE OCCURS by 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 MUSf 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 conflict of interest, but must
disclose the nature of the contlict before making any attempt to influence the decision by oral or written communication, whether
made by the officer or at his direction.
IF YOU INTEND TO MAKE ANY ATIEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH
THE VOTE WILL BE TAKEN: - -- d
. You should complele and file this form (before making any attempt to influence the decision) with the person~Sible for
recording the minutes of the meeting, who will incorporate the form in the minutes. ' I { ,
. A copy of the form should be pro~ided 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 con let of interest.
CE FORM KB ~ 1-91
PAGE I
I
IF YOU MAKE NO ATIEMPT TO I":lFLUENCE THEDECISION EXCEPT BY DISCUSSION AT THE MEETING:
. You sh'ould disclose orally the nature of your conflict in the measure before participating.
. You should complete the form and file it within IS days after the vote occurs with the person responsible for recording t!le minutes
of the meeting, who should incorporate the form in the minutes.
DISCLOSURE OF LOCAL OFFICER'S INTEREST
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, hereby disclose that on
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(a) A measure came or will come before my agency which (check one)
_ inured to my special private gain; or
inured to the special gain of ~_ +feJ.__w Arr. rlq. "'^':>
(b) The measure before my agency and the nature of my interest in the measure is as follows:
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NOTICE: UNDER PROVISIONS OF FLORIDA SfATUTES ~1I2.317 (1985), A FAILURE 10 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 $5,000.
::-f FORM M8-1-91
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