01 Neisen Kasdin 5/15/96 R9I
'7
FORM 8B MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER lOCAL PUBLIC OFFICERS
IASlNAMl' !-IRSI ~^Mr
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4-5
NAME Ot-" HOARD. COUNCil., COMMISSION. AUTHORITY. OR COM Mill EE
CoWl \ ~
THE ROARD. COUNCIL COMMISSION, AUTHORITY OR COMMIlTEE ON
WHICH I SERVE IS A UNIT OF:
'It ('ITY
CJ COUNTY
o OTHER I.OCAI. AGENCY
eln'
cou l'
MY POSITION IS:
~LErrIVE 0 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 elected 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 oflntetest will vary greatly depending
on whether you hold an elective or appoihtive position. For this reason, please pay ~Iose 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 IS DAYS AFTER 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 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'dtherwise may participate in a matter in which he has a conflict of interest, but must
disclose the nature of the conflict before makillg any attempt to influence the decision by oral or written communi~aiion, 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. r?;"""\
. 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 considpration of the matter in which you have a conflict of interest.
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CE FORM MB. 1..91
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IF YOU MAKE NO AlTEMPT 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 15 days after the vote occurs with the person responsible for recording the minutes
of the meeting, who should incorporate the form in the minutes.
... .
DISQLOSURE OF LOCAL OFFICER'S INTEREST
I, JJ/~;~Vl (), ~'v.
, hereby disclose that on
mUll 15
,I9OJ6 :
(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 d3rfl\(~ OVOS t
. by whom I am retained.
(b) The measure before my aj:~:te ~,~ur~fj:~inc:~:the~Jure is ~ ~\l~S:
. c;/ f&; /'1&
Date FIled
11IU
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 $5,000.
CE FORM KB. 1-91
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