Antwa L. Terry
MIAMw OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENC:AGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure for
1ST OF EACH YEAR W ACCORDANCE WITH SECTION 2-11.1(IC)(2) OF Tax Year Ending:
THE MIAMhDADE COUNTY CODE.
Name: Last First Middle
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FiNng as a (check one): Miami-Dade County Employee ~ ~
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~. Municipal Employee of: ~~ i a~ ~ ~ """~-'' ~ ~
Position Title: °-;
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County/Municipai Department: /Municipal Division: ~' ~~
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!f year home address is exempt from public records pursuant Work Telephone:
to Florida Statures § 119.07
please check here: ^ ,
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Mailing Address (Street Name and Number) Apt. #
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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. tf onntirwed 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~GO~ COUi,-~~ SCI~JJf ~OQ~ ~ eC~l`* ~f~(~ Mr. C2Sv~~ ~"la ~L~ ~1~v9Q.C.~C~
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i hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Oisdosing Date Signed
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