HomeMy WebLinkAbout1983 01 25 Regular
FORwl 4
~j~E~\jlORi\NDU~j1 OF VOT~rjG COpjFLICT
LAST NA,-IE - FU:ST NAME - r-llDDLE NAME
____ .uQ:6_L~G--e~f' _____
:-L\ILI)/G ADDRESS
\ \ 3~ ":P~'ET\SA(T\ C l~, ~f'V"-_~~
ZIP COUNTY
W ~ ~.E4(' -SP6-S I ~ L
NAMI:. OF AGENCY
OSTATE
DAT/01~1~1'~~CCURRED
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NA,-IE OF PERSON RECORDI>iG !\lINUTES
1VO/L'70-pJ
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AGE~;CY i.i unit of:
OCOUNTY
, hJJ4/Zy
TITLE OF PERSO)/ RECO~DI:-;G :'Il~;UTES
I <7--1 TY
SPECIFY
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CITY
~ lfu!UNICIPALUY
_~HER
CITY
(OY)\ ~ \SS I (; VI-'
:\~EMORANDUM OF CONFLICT Of INTERES~ IN A VOTING SITUATION [Required by Florida Statutes ~112.3143 (1979) 1
If you have voted in your official capacity upon any measure in which you had a personal, private, or professional interest which inures to
your special private gain or the special private gain of any principal by whom you are retained, please disclose the nature of your interest
below.
1. Description of the matter upon which you voted in your official capacity:
If PI) { IT t'tW "l-c R E ~ '- ft--r-t t1,d5
p&/L"y} iTlt IVCt- fJit)~~$.
Pc:.. t4 c e-lJ
0- 110 tH-b-
2. Description of the personal, private, or professional interest you have in the above matter which inures to your special private gain or
the special private gain of any principal by whom you are retained: '
"&-? { Gf:>C-/Z t V 7/-1 (..s C t' t r
.ffBsr II/IV t 6)
IIIJ
T7/-~
vd Te;--
-
~.
3. Person or principal to whom the special gain described above will inure:
a.~ Yourself b.O
Principal by whom you are retained:
(NAME)
SIG:-iATURE
--rATE ON WHICH FORM 4 WAS FILED WITH THE PERSON
RESPO)/SIBLE FOR RECORDING MINUTES OF THE MEETING AT
_'_<J3.u~b_~_ .... .._ _..._...l.=H~H T7.-j"JjRRED'__ .___..
~I
This m:morandum m~st be filed within fifteen (15) days follo\~ing the m~eting during which the votin~ con?ict occur~ed with the person I
[2SpOnslb!e for recording the minutes of the meptir-g, who shill! incorporate the memorandum in the meeting mmutes. ThIS form need not be :
f:!rd merdy to inJic2.te the absence of a voting conllict. Florida law permits but does not require you to abstain from voting when a conflict
of interest uises; if you vote, however, the conflict must be disclosed pursuant to the requirements described above.
FILING INSTRUCTIONS
.';OTICE: UNDER PROVISIONS OF FLORIDA STATUTES !;112.317 (1979), A FAILURE TO MAKE AKY REQUIRED DISCLOSURE CONSTITUTES
';nOUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: I:ItPEACH1\tENT, REMOVAL OR SUSPENSION FRO:.t OFFICI::
~);t E1\IPLOntENT, DI::1\:OTION, REDUC1'ION IN SALARY, REPRIMAND, OR A CIVIL PI::NALTY NOT TO EXCEED $5,000.
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FOR:'l -1 --REV-:-12~7-9-------- ------
FORivl 4 W3EN10R~t\NDUi\jl OF 'iOTH\jG CO~\jFL~CT
..LAST t;,^&~';:;f - iilD;~NAME~~" -- -----rENCY ""0" "' -ET i O~ /"~~J~"1:-VR "80---- ..
:--IAILIN ADDRESS, ~ C' - 0 ST ATE NAi:iE-OJRSO); RECORDI~G::ZI::-.lUT~--
. / <"" ~ { /~ , j/ /;1' t --,
fr:' D ~~-.!1f II-I i_:,t:.u___ ____________ OCOU~nY ~-!.-'!L{/+-,i{!~-htif.X /Z~-.17U_,
CrTY ~ ... .. . ZIP COUNTY I ,TITIEOFPEn.:;O:;P":CO~{DI.'G:,lI~,TJTF.S I
~- . '/"-!j(>/' S;J,E'.,i{;S_ F. - / :?.?'.~7D1j' ><' n?:i: ~'?LIU:dCli'i\.L ITY L___,____ i
NAJ\lJe. OF AGENCY '""\ / . SPECIFY
t I;;' 1'7 tv t r~- f:? ~Vfi-=> jLkjS DOTHER
( Cl T~'--
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,
,
: MeMORANDUM OF CONFLICT OF INTERES~ IN A VOTING SITUATION [Required by Florida Statutes 9112.3143 (1979) ]
I
! If you have voted in your official capacity upon any measure in which you had a personal, private, or professional interest which inures to
, your special private gain or the special private gain of any principal by whom you are retained, please disclose the nature of your interest
: below.
1.
Description of the matter upon ".'hich you voted in your offici~aci~y~1
~?.ye CJ-,0&-, I I c// .!3/7 /l/C
CfUIH ,{2./ IJ/Yl1 /
'}
C,,-'
o I. -r i'-~ S"
J'- ~ 1 v' ,,' I I..
7c.)-
~./
I ;1ILt?
2. Description of the personal, private, or professional interest you have in the above matter which inures to j"our special private gain or
the special private gain of any principal by whom you are retained: '
r /J,;rJ /l Bt;, I ~{J{' e
3.
Person or principal to whom the special gain described above will inure:
~
.d/?IR~
Principal by whom you are retained:
. c~ /., .-...,- -r-
~ A~:> l c2,rz.}-f/4)C (/lVZ)
(NAME)
a.JXl Yourself bfJ
SIGNA~~
;c;t:r1=
- -----; -- -- --~--- -- ---- - - - - -~~
"
DATE ON WHICH FORM 4 WAS FILED WITH THE PERSON
RESPONSIBLE FOR RECORDING MINUTES OF THE MEETfNG AT
WHICH THE VOTE OCCURRED:
.J---n.dI--)l?3~ -~-~-~- __n_n.
~ .- -- --_.~~:::..".
~--~
FILING INSTRUCTIONS
This memo!'andum must be filed within fifteen (15) days follov,;ng the meeting during which the voting conflict occurred with the person
re"ponsib!e for recording the minutes of the mepting, who shaH incorporate the memorandum in the meeting minuti;'s. This form need not be I
:ii~d merely to indicate the absl'ncc of a voting conflict. Florida law permits but does not require you to abstain from voting when a conflict I
.')f mtaest 2rj~es; if you \'Ote. however. the conflict must be disclosed pursuant to the requirements described above.
-' ......
~;OTlCE: UXDER PROVISIONS OF FLORIDA STATUTES S1l2.317 (1979), A FAILURE TO MAKE A~Y REQUIRED DISCLOSURE C02'\STITUTES
r;r.OUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWIKG: nIPEACH~lENT. RE~10VAL OR SVSPENSIO::-.l FRO:--! OFFICE
,),t E~,IPLOY:\IENT, lJEMOTION. REDUCTIO::-.lIN SALARY. REPRIMAND, OR A CIVIL PENALTY' NOT TO EXCEED $5,000.
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Foa:.l1- - REV. 12-7-9-------.----