Jackie D. Genard OUTSIDE EMPLOYMENT STATEMENT
MIAMw
~~ 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
' Disclosure fOf
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i(K)(2) OF
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11. Tax Year Ending:
THE MIAMhDADE COUNTY CODE.
Name: Last First Middle
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Filing as a {check one): ^ Miami-Dade County Employee
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Munidpai Employee of: l I ~ ~~ 1 ~ E F~ C ~{ ~ L
Position Title:
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County/Munidpal Department:
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~, CountylMunidpal Division:
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if your home address is exempt irom public records pursuant
to Florida Statutes § 919.07, please check here: ^ Work Telexone:
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Mailing Address (Street Name and Number) t ~• #
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City State Zip Code
Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. ff continued on a separate sheet, please check here:
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 swear (or affirm) that the aforesaid information is a true and correct statement. ~
Signature of Person losing Date Signed
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