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Oyer Form B Ea-tYNTON BERCH CITY CLERK GCT27 '20 e.-56AM FORM 8B MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL5 AND OTHER LOCAL PUBLIC OFFICERS DiST NAME IDB huWE :r;7NCIL,CO 0 A .11 ,41 SAS'OVI _,tA MAI_7o NG';UDRESS 0 THE BOARD,COUWALZOMMISSIOK AUTHORM OR CVM MMEE ON 7 HI SERVE ISA MT OF: A. COUNTY (3 GTFER LOCALAGENCY CITY LM my�Is— DATE ONWHICH VOTE OCCURAW MY POSITS 10 : Q iP-!2 Cl e-EcTIVEOI MiO MUST FILE FORM 88 This form is for use by any person serving at the county,ft or other local I 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 Intersect under Sedion 112,3143,Florida Statutes. Your responsibilities under the low when faced with voting on a measure In which you have a conflict of interest VAR vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay dose attention to the instructions on this form before completing and filing the form. E VATH SECTION 112.3143, FLORIDA STATUTES INSTRUCTIONS FOR COMPLIANC A person holding elective or appointive count)6'municipal,or other local public office MUST ABSTAIN from voting on a measure which would Inure to his or her special private gain or loss.Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on a measure which would inure to the special gain or loss of a principal (other then a governmerd 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 ort of a business associate.Commissioners of community redevelopment agendas(CRAs)under See, 103.356 or 163.357, RS.,and officers of Independent special tax districts elected on a one-acre,on basis are not prohibited from voting in that capacity. For purposes of this law, a'Telative' includes only the officer's father, mother, son,daughter, husband,wife.brother, sister, father4n-law, mother4n-law,son4n4aw,and doughter4n4aw.A'business assoclater means any person or entity engaged in or carrying on a 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 on any national or regional stock exchange). 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 staling 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 by completing and filing this form with the person responsible far recording the minutes of the meeting,who should incorporate the for in the minutes. APPOINTED OFFICERS: Although you must abstain from voting In the situations described above, you are not prohibited by Section 112.3143 from otherwise participating In these matters.However,you must disclose the nature of the confildt before making any attempt to Influence the decision, whether orally or in writing and whether made by you or at your direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE TAKEN: You must complete and file this form(before making any attempt to influence the decision)wi*th the person responsible for recording the minutes of the meeting,who will incorporate the form in the minutes. (Continued on page 2) CE FORM 8B-EFF.11/20113 PAGE 1 Adopted by reference in Rule 7.01D(1)(f),F.A.C. BOYNTON BEACH CITY CLERK. OCT277 '20 8.56AM APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. ® The form must be read publicAy at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION ATT 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 forin In the minutes.A copy of thea must be provided immediately to the other members of the agency,and the f® must be read publicly at then meeting after the form is Ned. URE OVLOCAL OFFICER'S INT REST hereby disclose'that on (a)A measure came or v`II 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 associale, JZ Inured to the special gain or loss of my reiafive,_A� CL,�*M,AU ® inured to the special gain or loss of by whom I am retained,or — inured to the special gain or loss of Pwhich 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 herest in the measure Ises follows: av LQ r vu� 1 4511 -11:11i e- (04OL' r 01 lo info ve ng tto If disclosure of specill rm lonmu violate confidentiality or privilege pursuant to law or rules go ml a rneM 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. Date riled Signature NOfICE: 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$10,000. CE FORM 8B-ErF.1112013 PAGE 2 Adopted by reference In Ruls,34-7.010(1 X0,FAC.