10/31/1985
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(b) The measure Dn which I abstained and the nlUure Df my interest in the measure is as fDllows:
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Please see PART C fDr instructions Dn when and where tD file this fDrm,
PART B
VOTING CONFLICT DISCLOSURE FOR STAT! OFFICERS
[Required by SectiDn 112,3143(2), Aorida Statutes (Supp. (984),}
Each Itate public Dfficcr is permitted tD vote in his (lfficial capacity on any matter. HDwever, allY ltate Dfficer whD,votcJ in his official
capacity upDn any measure which inures to his special private gain or the special Rain Df any principal by whom he is retained is required
to disclose the nature of his interest as a public record in P.l.n B below within IS daYI after the vote occun.
I, the undersiRned officer of a state aiency, hereby disclose that on , 19 _:
(a) I voted on a matter which (check one):
_ inured to my Jpecial private gain; or
_ inured to the special gain of
. by whom I am retained.
(b) The measure on which I voted and the nature of my interest in the measure is as follows:
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Date Filed
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Pleue ICe PART C below for instructions on when and where to file this form,
PART C
FILING INSTRUCTIONS
nii memorandum must be filed within fifteen (I S) days followin. the meeting during which the volina conflict occurrd with the p:r1on
responsible for rccordinathe minutes of the meeting, who shall incorpDrate the memomndum ill the mectil1i minutes. This form need not
be filed merely to indicate the absence of. votina conflict. '
NOna: UNDEIll'1l0VIStONS OF FLOIlIDASTAT11TES,IIUUCI9Ul, A FAILURE TO MAltE ANY REQUtRED DtSCLOSURECONsnTUTES OIlOUNDS FOil AND tot A 'I'
IE.PUNIIHID IV ONE Oil MOlE OF THE FOLLOWtNO; IMPEACHMENT. REMOVAL OR SUSPENSION FIlOM OFFtCE Oil EMPLOYMENT.
, D~MonOM, IEDUenOM,I" IALA.V. RE'.IMAND. O. A CIVIL PENALTY NOT TO EXCEEDU.ooo.
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