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Fort Walton Beach Council minutes — 11-23-2010 regular — reading text

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hereby disclose that on November 23 , 20 a) A measure came or will come before my agency which ( check one) inured to my special private gain or loss; inured to the special gain or loss of my business associate, inured to the special gain or loss of my relative inured to the special gain or loss of _, by whom I am retained; or which inured to the special gain or loss of _ --, 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: A Resolution of the City of Fort Walton Beach designating a brownfield area in the City ( Res. 2010 -42). I declare a conflict of interest as I am the beneficiary of a trust on property located at 16 Robinwood Drive, which is in the proposed brown field, and I abstain from the vote. November 23, 2010 Date Filed Signature Michael Holmes NOTICE: 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 86 - EFF. 1 /2000 PAGE 2

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