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Raymond Franklin Chambers
MI OUTSIDE EMPLOYMENT STATEMENT ~- - 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 IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF TH M D Disclosure for Tax Year Ending- E IAAM- ARE COUNTY CODE. Na st ~~ ~ F' ~y~~~ Middle - ~ ,,v Filing as a (check one): ~ Miami-Dade County Employee // unicipal Employee of: i//_~1~1 ~~j7 Position Titl e: / ,~ ~,~ County/Municipal Department: /~l/~ l g~G~ ~o~,~ ~ ~ r County/Municipal Division: ff your home address is exempt from public records pu uant Work Telephone: to Florida Statutes § 119.07, please ci-eck here: ~ ~~ r ~ 67~ ~ /' Mailing Address (Street Name and Number) Apt. # ~o~N •, ~~ ~P F~ City ~ State l ~ ~ ~ O Z~ e ~~ ~ l Please list the sources of outside employment, the nature of the work and the amounts of money or other compensation you received. tf continued on a separate sheet please check here: Name and Address of the Source of O u t s ide Income Nature of the Work Per fo rmed Amount of Money or Compensation Rece ived ~ f- " ~/ ~~ / ~~~YIy~`.'1C.. 7~~ jl.L!(,L?vv ~ I~ ` ` ~ D /~~/./~ p j~ rV~Y~W~{~-(~~ '"~`<<~ , "' °~(7 ~~~~C~ILl` L ~ ~ ( . Q 1 l v v ~ ~!~c~ ~l'A~ ^ ~t/'~M~~~ ~ (~''l''~~~j~ C_? N A --i o _~ C.._ i, C r-- r-- ~'' 1 I hereby swear (or affirm) that the aforesaid information is a true and correct statement. © ~ -,~ ,- re of Person isc ~ Date Signed - (-. .c- L7 ...1 ~a2~oo