Victor Rybalka
MI~~ OUTSIDE EMPLOYMENT STATEI~I~~1~~ - ~ PP1 2
For Full-time County and Municipal Employees _
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
1ST OF EACH YEAR !N ACCORQANCE WITH SECTION 2-11.1(Kj(2j OF pisclosure for
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THE MIAMhDADE COUNTY CODE. Tax Year Ending:
Name: Last First ~ Middle
Filing as a (check one); ~ Miami-Dade County Employee
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~. Muniapal Employee of: /~ [ ~~~~ /''~~~ ~j~GG~
Position Title:
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CouMy/Municipal Department: Counry/Municipal Division: n o
If your home address is exempt from public records pursuant Work Telephone: - 4
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to Florida Statutes § 119.07, please check here. ~ p f,,_
Mailing~A`ddress~(Street Name and Number) ~- Ap,~ ~ '
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Please list the sources of outside employment, the nature of the work and the amourrts of money or other
compensation you received. tf continued on a separate sheet, please dteck he-e:
Name and Address of the Source of
Outside I
n
c
o
me Nature of the Work
Performed Amount of Money or
Compensati
n Received
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I hereby swear (or affirm) that the aforesaid information is a t-ue and eorrec.K statement.
Signature of Person Disclosing Date
Signed
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