Rafael Ojeda M
~ OUTSIDE EMPLOYMENT STATEMENT
MI
~ 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 piscioSUre for ~p
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF TaX Year Ending:
THE MIAMI-DADS COUNTY CODE:
Name: Last First
~A~'A Middle
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Filing as a (check one): ^ Miami-Dade County Employee
Municipal Employee of: ~~4ry1~ '~~~
Positron Title:
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Courliy/Municipal Department: ~ County/Municl I Division:
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if your home address is exempt fmm publ~ reds rsuanf
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k h Work Telephone:
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ere:
to Florida Statutes § 119.07, please chec ~
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Mailing Address (Street Name anal Number} p`~• #
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City State ZP Code.
~'Q~,~ ~~ 33t2~
Please list the sources of outside employment, the nature of the work and the amourrts of money or other
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compensation you received. if continued on a separate sheaf; p
Name and Address of the Sounre of
ide income
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O
u Na#ure of the Work
Perfon~ned Amount of Money or
Compensatlon Received
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1 hereby swear r affirm) that the aforesaid information is a true and correct statement.
-Signature of n 'solos ng Dat S' ned
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