James A. Martell
ZOQ9 JUL - I . AM . 8~ 19
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MIAM OUTSIDE EMPLOYMENT STATE` ~L~~~'s~
For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING iN OUTSIDE
EMPLOYMENT MUST FlLE AN ANNUAL DISCLOSURE REPORT BY JULY Disciasure for
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1ST OF EACFI YEAR IN ACCORDANCE vurrH SECTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADS COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee ~ `
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Muniapal Employee of: 17'1 OF /
Position Title:
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Cou /Municipal Department: ~ County/Municipal Division:
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!f your home address is exempt from public records rsuanf Work Telephone:
ro Florida statutes § ~ t 9.07, please check here: [~ ~ ~ ~ ' ~ 7 3 ~ 7~ 3 ~
Malting Address (Street Name anal Numbers Apt. #
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City -~, State Zip Code_
/~'1 f ern ~ `2. 3 3 /' S' 7
Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. If contatued on a separate sheep please check here: ^
Narne and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Comper>~ation Received
1 hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing Date Signed
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