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HomeMy WebLinkAboutForm 8B - Andrew RaskenFORM 8B MEMORANDUM OF VOTING CONFLICT FOR II COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS AST AM -FIRST NAM MIDDLE NAME , 1.5 - iAliAit81(/ E1‘ NAME OF BOARD, COUNCIL, C MMISSION, AUTH i RITA, OR COM ITTEeeptA gre,,.-,_, 04 1,0"et rit ' MAILING ADDRESS 3i 6 ilit. 4flAt ‘ 'I Igrige THE BOARD, COUNCIL, COMMISSION, AUTHORITY OR COMMITTEE ON WHICH I SERVE IS A UNIT . Pam, JCOUNTY OTHER LOCAL AGENCY CITY COUNTY re4(4ini (DAD NAME OF POLITICAL SUBDM ION: DATE ON WHICH VOTE OCCURRED MY POSITION IS: MI ELECTIVE APPOINTIVE WHO MUST FILE FORM BB This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies equally to members of advisory and non -advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before completing the reverse side and filing the form. INSTRUCTIONS FOR COMPLIANCE WIT SECTION 112.3143, FLORIDA STATUTES person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which ,nures to his or her special private gain or loss. Each elected or appointed local officer also is prohibited from knowingly voting on a mea- sure which inures to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent organization or subsidiary of a corporate principal by which he or she is retained); to the special private gain or loss of a relative; or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies under Sec. 163 356 or 163.357, F.S., and officers of independent special tax districts elected on a one acre one -vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in-law, and daughter-in-law. A "business associate" 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 stating 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 responsibleresponsiblo for recording the min- utes of the meeting, who should incorporate the form in the minutes. * APPOINTED OFFICERS: * * * Although you must abstain from voting in the situations described above, you otherwise may participate in these matters. However, you must disclose the nature of the conflict 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 WJLL BE TAKEN: • You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the minutes of the meeting, who will incorporate the form in the minutes. (Continued on other side) APPOINTED OFFICERS (c0nt0Ued) ^ Acopy ofthe form must beprovided immediately tothe other members ofthe agency, ^�The form must beread publicly atthe next meeting after the form iafiled. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: ` ^ You must disclose orally the nature of your conflict in the measure before participating. ^ You must complete the form and file it within 15days after the vote occurs with the person responsible for recording the minutes ofthe meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the ogenoy, and the form must be read publicly mtthe next meeting after the form is filed. , DISCLOSURE OF LOCAL OFFICER'S INTEREST 04.az 4k, ^ hereby disclose that on (a) A measure came or will come before my agency which (check one) — _^2O_1 6 : inured 1omyspecial private gain or�000 inured tothe special gain orloss ofmybusiness associate, � inured tothe special gain orloss ofmyrelative, � inured tothe special gain urloss of .by whom |amretained; nr inured to the special Qain or loss of ^which is the parent organization or subsidiary of a principal which has retained me. (b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: o _� � ��/ �x�`�m� W uv\ Date Filed I?df-r 4;444 NOTICE: UNDER PROVISIONS OFFLORIDA STATUTES §112.3Y7.AFAILURE TDMAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAYBE 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 TOEXCEED $1U.00U.