Aifa AlvarezM,
~ OUTSIDE EMPLOYMENT STATE111lEN ~~ ~+
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For Full time County and Munlclpal Employes M 4
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE CITY G ~. E i~ ~(~ S O
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY .IULY
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Di8ClOSUre fOi
Tax Year Ending' 2'd ~
THE MU1MI-DADS COUNTr CODE.
Name: Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee
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uniapal Employee of:
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Position It
County/Municipai Departmerrt: Cnounty/AAunicipai Division:
If your home address is exempt public recorris pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ^ .3056 ~ (~
Mailing Address (Street Name and !Number) Apt. #
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City State Zip Code
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Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. Jf continued on a separate sheet, please check here: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
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1 hereby swear (or affirm) that the aforesaid information is a true and correct staternerrt.
Signature of Person Discl Date Signed
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