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<br />, <br /> <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 /> <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, <br /> <br />DISCLOSURE OF LOCAL OFFICER'S INTEREST <br />~ U ~'f? l rr IV!? r !fJ+ ' hereby disclose that on d.. - / ') <br />(a) A measure came or will come before my agency which (check one) <br /> <br />,20~: <br /> <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 />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 />, by <br /> <br />, which <br /> <br />WDr K.... <br /> <br />70 6p J;o~ <br /> <br />/~ If 11141/, ~ <br /> <br />:t.skJ <br /> <br />ruh lOt, <br /> <br />, <br /> <br />-I-/frv <br /> <br />IJ- Irope,. it <br /> <br />OW fie Jt... . <br /> <br /><3/2,/0 7 <br /> <br />/)~~ <br /> <br />Date Filed <br /> <br />Signature <br /> <br />NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES 9112.317, 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 88 - EFF. 1/2000 <br />