Andrea L. Palacios OUTSIDE EMPLOYMENT STATEMENT
MIAMw
~~ For Full-time Coun and Munici al Emplo ees
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FULL TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure foi
1ST OF EACH YEAR IN ACCORQANCE WITH SECTION 2-11.1(I~(2) OF Tax Year Ending:
THE MiAMhDADE COUNTY CODE.
Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee
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Muniapal Employee of:
Position Title:
County/Municipal Department:
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~ Courrty/Municipal Division:
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If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ^ .~J. ~a 3_ ~~~ ~ /a
Mailing Address (Street Name and Number) Apt. ~
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City State Zip Code
Please list the sources of outside employment, the nature of the wolic and the mounts of rrroney or other
compensation you received. ff continued on a separate sheet, please check hem: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outside income Performed Compensation Received
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I hereby sweaa~ (or affirm) that the aforesaid information is a tn~e and correct staternerrt. `~~' ~
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Si ure of Person Discl Date Signed ~, ca
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