Barbara Perez IAM OUTSIDE EMPLOYMENT STATEMENT
~ For Fu[{-time Cou and Munippaf Employees
Fuu: TINS COUNTY AND MUt~gC~PA~ E~IPI~DYEES~o IN OUrS~E ~-, ~
EMPLOYMENT MUST FM.E AN ANt~Ai. DICE REPQRT BY JULY ~ for -°t .°v
1si of EAa~+ YEAH w acCORO~wce WITH SECTtoN 2-11.t(K)(2) OF Tax Year EadMg: ~ -~ c._
TriE Mw~-Oates CourrrY CODE. ~''
Name: mast First Middle ; `
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Filing as a (check one): ^ Miami-Dade CourrRy Employee
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Munidpai E~~ ~' r-,
Position Title:
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untyMlunicipal Department: C.o~x~ty/Munk~pai Division:
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if ynur Horne aoYlress is exempt from public records pursuant Work Teleptwrre:
ro Statutes § ~ ~s.o~, please cHec~c Here: ^ ..~ ~o
Making Address (Street Name and Number) ~. ~
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City State Zip Code
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Please list the souroes ~ outside employment, the 'rat'''e of the work and the amourrts of rrroney a otl~er
compensation you n~r-ed. li ooMmued ort a ssp~e s~lteet, please' check Here: ^
Name and Address of the Source of t~tur~e of the Work Amount olf Money or
Outside income PerfornNd Compensation Received
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I hereby swear (or affirm) that the aforesaid irtforrr~aRion is a true and oornsct meM.
Signature Disckrsing Date Signed
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