The undersigned is a member of the _________________________________________ of the Town of Briny Breezes, Florida, and hereby requests that a (Check One) [ ] Meeting [ ] Workshop Session [ ] Other Type of Assembly (Specify:_____________) of the members of the aforesaid group be called to order and held at (Check One) [ ] the Briny Breezes Town Hall, 4802 North Ocean Boulevard, Briny Breezes, Florida, or, if other, check and specify [ ] ________________________ on (date and time) __________________.
This request that the members of the aforesaid group shall be called into assembly is for the following reason or purpose: ___________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
The signature of the Member making this request signifies that member’s consent and vote agreeing to convene the assembly.
Signed: ___________________________________________________ Date: ____________
Member of the aforesaid group of the town, and Title
NOTICE TO THE TOWN CLERK FOR DELIVERY TO THE OTHER MEMBERS OF THE AFORESAID GROUP OF THE TOWN OF BRINY BREEZES
THE TOWN CLERK Pro Tem, is hereby directed to proceed without delay to present this request to the other members of the aforesaid group of the Town of Briny Breezes who are present and available to vote thereon. Upon receipt of this request, the aforesaid members, without discussion among themselves, shall promptly signify their agreement or disagreement therewith, sign their names in the spaces provided, and return this request to the Town Clerk Pro Tem, for further processing. When the response from the other members has been completed, the Town Clerk Pro Tem, shall promptly tally the votes and inform all of the members of the group as to the results. If a plurality of the members vote in agreement with the Request for Assembly, the assembly of the group shall be held as requested, but not otherwise. Whenever a request for assembly is approved, the Town Clerk shall promptly post a true copy of the completed request as a form of public notice thereof.
Group Member’s Name Signature Date Vote
_________________________________ ____________ [ ] AGREE [ ] DISAGREE
Chairperson
_________________________________ ____________ [ ] AGREE [ ] DISAGREE
Alderman
_________________________________ ____________ [ ] AGREE [ ] DISAGREE
Alderman
CERTIFICATE BY TOWN CLERK PRO TEM
I HEREBY CERTIFY that I have presented this Request for Assembly to the members of the aforesaid group of the Town of Briny Breezes who have signed, dated and endorsed their responses thereto, and by tally of their votes, the members of the group have decided that they
(Check One) [ ] AGREE [ ] DISAGREE
with the above Request for Assembly as submitted.
_____________________________________ Dated and Posted: __________________
Town Clerk, Pro Tem
(Ord. 3-2012, passed 11-29-2012)