Derrick Lanier LundyM
~ OUTSIDE EMPLOYMENT STATEMENT
~ For Full-time Coun and Munici 1 Em 'lo ees
h/ Pa p Y
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING ~ OUTS~E
EMPLOYMENT MUST FILE AN ANNUAL OISCLO.~IRE REPORT' 131f .IULY
OF
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1ST OF EACH YEAR IN ACCO~ANCE WITH Tax Year Ending:
TILE MwMI-D1N)E COUNTY CooE.
Name: Last First Middle
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FlNng as a (deck one): ^ Miami-Dade County Employee
~Muniapal Employee of: CI~~ rrF MI /~ r ~ ~~-Q-~
Position Title:
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County/Municipal j 1 pF ~RI'1n1
k'1 CouMy/Municipa! Division:
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If your home aakir+ess is a empt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check hens: ^ 305 la ~ 3 7 (pl !o
Mailing Addn~ss (Street Name and Number) Apt. #
City State Zip Code
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Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. If contiruied on a separate sheet, please check here: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outs
In
come
i
de Perform
ed Compensation Received
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I hereby swear (or affirm) that the afon>said information is a true and correct statement. `~' "'D
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re of Person 'sclosing Date 'red ~"° ..
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