12 Neisen Kasdin 9/10/97 R5A"' 'FORM 8B MEMORANDUM OF G CONFLICT FOR"
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
WHO MUff FILE FORM 8l
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, IL~lpplies equally to members of advisor~ and non-advisory bodies who ar~ presented
with a voting conflict of interest under Sect!on 112.)14), 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 ~verse side and filing the form.
INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
ELECTED OFFICERS:
A person homing 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 reraincd.
In ~lther 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 F~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 oth{rwise may participate in a matter in which he has a conflict of interest, but must
disclose the nature of the conflict 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 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 influence the decision) with the person responsible for
recording the minutes of the meeting, who will incorporate the form in the minutes. u~nflic
· ich yo t of interest.
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IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
· You should disclose orally the nature of your conflict in the measure before participating.
· You should complete the form and file it within I .q days after the vote occurs with the person responsible for recording the minutes
of the meeting, who should incorporate the form in the minutes.
DISCLOSURE OF LOCAL OFFICER'S INTIRIST
,. ~,,,,, . be.~ discl.e ,hat o. ~ ~. :; '~ 7:
(a) A measure c, ame or will come before my agency which (check one)
inurcd to my special private gain; or
ate Filed Signature
)TICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317 (1985), A FAILURE TO MAKE ANY REQUIRED
]CLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING:
PEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN
LARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000,
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