Laserfiche WebLink
<br />APPOINTED OFFICERS (continued) <br /> <br />. A copy of the form must be provided immediately to the other members of the agency" <br />. The form must be read publicly at the next meeting after the form is filed" <br />IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: <br /> <br />. You must disclose orally the nature of your conflict in the measure before participating. <br /> <br />. 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 <br />meeting, who must incorporate the form in the minutes, A copy of the form must be provided immediately to the other members of the <br />agency, and the form must be read publicly at the next meeting after the form is filed. <br /> <br />I, Jf(Y/JpJ S <br /> <br />DISCLOSURE OF LOCAL OFFICER'S INTEREST <br /> <br />~Dac JI <br /> <br />, hereby disclose that on <br /> <br />P fZ 01Pi:-"?Z- <br /> <br />I Y- <br /> <br />200' . <br />, -' <br /> <br />(a) A measure came or will come before my agency which (check one) <br />~ inured to my special private gain or loss; <br />inured to the special gain or loss of my business associate, <br />inured to the special gain or loss of my relative, <br />inured to the special gain or loss of <br />whom I am retained; or <br /> <br />, by <br /> <br />inured to the special gain or loss of <br />is the parent organization or subsidiary of a principal which has retained me" <br />(b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: <br /> <br />, which <br /> <br />~~f1jJ1ISS~~~ /ll'j>;(uv!h- t? r <br />tTiJ 'f I~ E e iT 7 tJ i:: If tJ f'S <br />/f H ,.t'{ 15 H-vfll6~ J!II 6- Me <br />It- i}/;4 ~ j} I fI) fe 6 I yO 0 7 <br /> <br />!l t! ; '7 7' f)o /J IJ-'{I () .J <br />If Ct/IlRI '(.4/3 C i!J;(G/f,lt.l/2#'7IoAJ <br /> <br />, I <br />W I 'It! /1f~1 R \\ SfJRl'1 oP L I FE <br /> <br />Del &11r?j,q( <br /> <br />I~ <br />, <br />, <br /> <br />'vOO b <br /> <br />~U,JJ4M7-- <br /> <br />j(gnature .I <br /> <br />/ <br /> <br />Date Filed <br /> <br />NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES S112.317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE <br />CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, <br />REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A <br />CIVIL PENALTY NOT TO EXCEED $10,000, <br /> <br />PAGE 2 <br /> <br />CE FORM 8B - EFF" 112000 <br />