George L. VaronM1 OUTSIDE EMPLOYMENT STATEMENT ~Qy~~~ -
~- For Full-time County and Municipal Employees C/ T y ~,. ,,. ,
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(K)(2) OF DISCIOSUre for
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THE MIAMI-DARE COUNTY CODE. ax
ear Ending•
Name: Last First Middle
Filing as a (check one): ~ Miami-Dade County Employee
Municipal Employee of: /!i1 ~.j}y~ , ,~~~,j{~ ~' `~
Position Title:
County/Municipa
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D
epartment: County/Municipal Division:
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ff your home addr>sss is exempt from public records p uant Worts Telephone:
to Florida Statutes § 119.07, please check here:
Mailing Address (Street Name and Number)
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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. If continued on a separate sheet, please check here:
Name and Address of the Source of
Outside Income Nature of the Work
Performed Amount of Money or
Compensation Received
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I hereby swear (or arm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing Date Signed
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