11-06-2023 - Minutes Back UpFORM 8B MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
LAST NAME -FIRST NAME -MIDDLE NAME
NAME OF BOARD, COUNCIL, COMMISSION, AUTHORITY, OR COMMITTEE
MAILINGADDRESS
THE B�ARD, COUNCIL, COMMISSION, AUTHORITY OR COMMITTEE ON
)2"C-ITY 0 COUNTY C2 OTHER LOCAL AGENCY
CITY COUNTY
NAME OF POLITICAL SUBDIVISION:
DATE ON WHICH VOTE OCCURRED
MY POSITION IS:
JZIELECTIVE El APPOINTIVE
WHO MUST FILE FORM 813
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 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 voting on a measure in which you have a conflict of interestwill vary greatly depending
on whether you hold an elective or appointive position. For this reauon, please pay close attention to the instructions on this form before
completing and filing the form.
INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
Aperson holding elective mappointive county, municipal, mother local public office MUST ABSTAIN from voting onameasure which
would inure to his or her special private gain or loss, Each elected or appointed localofficer also MUST ABSTAIN from knowingly voting on
o measure which would inure to the special gain or loss of principal (other than a government agency) by whom he or she is retained
(including the parent, subsidiary, or sibling organization of a principal by which he or she is retained); to the special private gain or loss of a
relative; or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies (CRAB) under
Sec. 163.850 or 183,357. FS., and offioorm mfindependent special tax districts elected on a ono -acro, one -vote basis are not prohibited
from voting inthat capacity.
For purposes of this law, a "relative" includes only the officer's father, mother, aon, daughter, humband, wife, brother, aia1er, fothepin-|aw,
mothepin-|mw, uon-in-law, and daughter-in-law. A''buminoum aamociote^^ mnmou any person orentity engaged in or carrying on o business
enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (where the shares of the corporation
are not listed onany national orregional stock oxohange).
ELECTED OFFICERS:
In addition to abstaining from voting in the situations described above, you must disclose the conflict:
PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure onwhich you are
abstaining from voting; and
WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this honn with the person responsible for recording the
minutes ufthe meeting, who should incorporate the form inthe minutes.
Although you must abstain from voting in the uduuhmna described yhove, you are not prohibited by Section 112.3143 from otherwise
participating in these matters. However, you must disclose the nmom of the conflict before making any attempt to influence the decision,
whether orally orinwriting and whether made byyou oredyour direction.
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
~
You must 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. (Continued on page 2)
csFORM oe-EFF 11mo u PAGE 1
APPOINTED OFFICERS (continued)
• A copy of the form must be provided immediately to the other members of the agency.
• The form must be read publicly at the next meeting after the form is filed.
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose orally the nature of your conflict in the measure before participating.
• You must 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 must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the
agency, and the form must be read publicly at the next meeting after the form is filed.
DISCLOSURE OF LOCAL OFFICER'S INTEREST
E
W r,'. , hereby disclose that on I"J e tir c w � C-�- _ 20
(a) A measure came or will come before my agency which (check one or more)
inured to my special private gain or loss;
_ inured to the special gain or loss of my business associate, ;
inured to the special gain or loss of my relative,_,„-
inured to the special gain or loss of
whom I am retained; or
inured to the special gain or loss of
is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me.
(b) The measure before my agency and the nature of my conflicting interest in the measure is as follows:
, by
, which
If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer,
who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way
as to provide the public with notice of the conflict.
v'j ey w ✓ � t c� -L
Date Filed Signatu
NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE
CONSTITUTES GROUNDS FOR AND MAY BE 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 $10,4700.
CE FORM 86 - EFF. 1112013 PAGE 2
Adopted by reference in Rule 34-7.010(1)(f), F.A.C.