HomeMy WebLinkAboutItem #27 - Discussion ItemiI I) 6Oti NVIRCIi VOTO OCC'Ut:RED:
L'e I-Vil 4 L]JOsi�)'r�s�DUM VFF VOT161a Ca"AFLICT
( 83
PART A
DAWKINS -MILLER--- —_ _-- — J. ---------- ----- ----- ----- Tc}ellhf)n�,; _ 305--- 579-6026
(LA5T1 (FIRST) (A/C1 fr;V'oik)-
1385 N.W. 50TH STREET _ MIAMI__ FL 33142 D A D E
f STREET) (CITY) (ZIP LUDF) (COuNi-Y)
FART E3
Ar;eticy is a Unit of [check onel : ( ) State of Florida; (X) County, City or other Political Subdivision;
Name of Agency: -__- MIAMI CITY COMMISSION
PoFition held in Agency: CITY COMMISSIONER
PART C
1IEIIORANDU31 OF CONFLICT OF INTEREST IN A VOTING SITUATION []icgttircd by § 112A143, f.S., 19T51
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: LAND USE VARIANCES
REQUEST BY JACAROL BAY CLUB
2. Description of the personal, private, or professional interest you have in the above matter which inures to you Special
private gain or the special private gain of any principal by whom you are retained:._
I am going to rent space at Jof f\ae 11 _to_oper_ate-
a business of a Health Care Service Center
3. Person or principal to whom the special gain described above will inure:
a. (X ) Yourself b. ( ) Principal by whom you :(re retaitlyd :
PART D
FILING INSTRUCTIONS
This mc•lnormiduln must be filed within fifteen (15) dcly; fol,l')%,il:;- tl,e rn(;tinry (lr,r;rr \.'hip ! tll-
.%vitil t}le per:•on ret�pollsible for revording the n1i11LltVA Of 11Wt-
hqv- nihmics. This form need not be filed nlel'ely to indicate) lhc• ab-encc of ;: \Otiu_; (f,nflict. I'L ri)i:l Inv- 1w rnii•: b,;t doe.;
11Ut rewire yoll to abstain front voting wheel :1 CONfliCt Of you (.I- llut, bl \.;\ -r' tl..o ('011.
flirt must be disclosed pursuant to the re(jtlirenlents (1(•-rl'il) (1 .111O (•.
PART F-
SIG(YAT(, F OrPERSON DISCLOSING D%•.'iL t•i".:'. .:0
NOTICE: UNDER PROVISIONS OF SECTION 112.317, FLOP.IDA STATUTES, 1975, A FAtLURe TO 1`4 ,EE Z NY 1:: c)li!2ED D)SC! OSU n
CONSTITUTES GROUNDS FOR AND MAY BE PLINiSHED BY ONE OR M.O"E OF THE FOLLO':IiNG: Vi+ "'F'.CIK IENT, REMOVAL O• SUS-
PENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, PE'z:tYilAND, 0-1 A CIVIL p_?a.l.;Y NOT TO EXCEED
$5,000.
CC FUAM • - FFF. 10/1/75