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Giancarlo (John) Antona I~ AoE OUTSIDE EMPLOYMENT STATEMENT - For Full-time County and Municipal Empioyees FULL-TIME COUN7YAND 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 THE MIAMI D Disclosure for L1 Tax Year Ending: ~2 •3~- 2Dfl_I . - ADE COUNTY CODE. , Name:.. -Last A ~t ~ 10 K a First t'4lA~ti;~~.l.p Cw~~ l Middle Filing,as a (check one):. ~ .Miami-Dade County Employee . " .Municipal Employeeof: ~ I , .--~~KI ~~l~~kl Position =Title° CE4~~~. ~dR oR INSP~GToR .County/Municipal Department:. ~ ra~~~~N~ ~ County/Municipal Division: pi:Y~:. ~~~~. ~~~«o~ If your home address is exempt"froin. public records pursuant Work Telephone: to Florida Statutes § 119.07, please check here: © 30~, 6`?3,~Jppp ytr 6~'~3 .Mailing Address (Street Name and Number)' Apt # . 88.$011o~Tb LAKE D~aa ~~6 ~ .' ,City ; . r - State Zip Code ?eta i ~o~ ~ FL . 33324= . P Please list the sources of outside employment; the nature of the v+rock 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 Nature of the Work" Amount of M"oney_ror Outside~lncome ., Performed Compensation-fReced a - E~cC~t.W~IMESS, l _. =~.DKt~:~t,.t~su~~cE l~,. ~ . ,r - ~EPo~.i S c, -,~ ~ -~ ~~ ; ,~ 1 heregy swear (or a )that the aforesaid information is a true and correct statement. Signature of'Person osl Date Signed . .. ~ G•~To ~ ~2~ z~lo . ,AYER'S name, street address, city; state, ZIP code; and telephone no. ~ 1t y 1 Rehts ~ -_ ...OMB NO. `1545-0115 •' ~ `' ~ ""'- ~ ). ADMIRAL INSURANCE COMPANY ' t . " ° . :: ; 1255.CALDN7ELL ROAD CHERRY HILL NJ D8034 ,... ~ , 2009 ~~ . _.: ... Miscellaneous . , . 856-429-9200 ~ 2 Royalties . ~ - Income form 1099-MISC ' PAYER'S federal-identification number ' RECIPIENT'S identification number 3 Otherincome ~- ; 4 Federal income tax withheld Copy B ~ . ' ~ For Recipient 22-2235730 65-0788264 ' This is important tax RECIPIENT'S name, streetaddress, city, state, and ZIP :code 5 Fishing boat proceeds ~ 6 Medicate and health care payments information and is VERTICAL TRANSPORT TECHNOLOGY CORP being famished fo 8880 NORTH LAKE DASHA DRIVE - the Internarffevenue ,, . : - -. _ ,,:; -. _ .~„_ _.~.;ti~ ~, _,.~,- ,~T._ ' .._ 'rL`ikN`IH"IIVV, I-~ S3:i24 - -: - ~ 7o-.Nenem ~ ee.com e~satien = f•.P .z-__.._-, ~ Y_ 3.`;uh ritute pa merirc n. li u: ef.~1n idends~, - ~' ~. i t t "-` If you Service are required to-file'a°•""` - _ $1 ,875 00 or n eres . ~ return, a negligence - . penalty or other ' " ~ 9 Payer madedirect sales of 10 Cropinsurance proceeds sanc4ioo-may be ' - 55,000 or more of consumer - - imposedon you if - ~ ~ products4o a buyer ^ ~ ~ this income is = ~ (recipient) for resale ~ .taxable andtheIRS _ - - ~ 11 ~ ~ 12 - determinesthatit - . ~. ~ ~ ~ - ~ has not been - ~ ~ ' - - re orted - Accountnumber jsee instructions) ~ - ~ 13 Excess golden parachute payments ~ 14 Gross proceeds paid to an attorney - p . - .. ,. .. ~ , 15a Section 409A'deferrals. ,~. °+ `" 15bSectioh`409A income"''~, ° 16 State taz~withheld, ~ - ~ 17 State/Payer's stateno.` - -. _, -. . 18' State income , . , ,. _1. ` FL ~, ~xVs .; Form 1099-IVIISC '~ ~ - ` "~ (keep for your records) " ,.. .. E -.. ~ .-,.. .. .,, ; - ~ -,~w `Department of the. Treasury'-Jnternal Reveritie.Service ; . _ ~. .-, ., ,. .• . ,; . .1:099=Msc 'Instrluctions for ~Recipierts' '~ ~ - ~ -~ ~ ~ ~ ~~ A- . ~~ ~- ' : ' Account number~~May show an account or other unique number the payer assigned to~ ~ t . SE income, report this amount on Schedule C, C-EZ, or.F (Form 10401;¢and complete ~ ~~ ' ~ ~distinguish.you(account. ~-' ": ' ~ _ ~ ~ _ - ~ ~ ,~ . -Schedule SE (Form 10401 You received this form iristead of Form W-2 because the'payer - . - Amounts showmmag be subject to self-employment (SEI tax. If your net income from did not consider you an employee and did not withhold income tax or. social sequrityLLand . ~ - ~ ' -~ ' self-employment`is 5400 ormore, you.must file a return antl compute your,SE tax on Medicare tax. Contact the payer if you .believe this form is:incdrrect Or has been issued ~' - - ~ Schedule SE (Form 10401. See Pub. 334 for more information. If noincomeor social security in error. If you believe you are ,an employee and cannot get.thiS form corrected, report _ - and Medicare taxes were. withheld and you are still receiving these payments, see Form ~ the amount frombox 7 on~Fdrm 1040, IineJ for Form 1040.NR, line 81. You must also - - - 1040-ES, Estimated Tax for Individuals. Individuals must report asexplained for box 7 below. complete and attach to your return'Form 8919, Uncollected Social Security and Medicare Corporations, fiduciaries, or partrierships'report the amounts on the .proper line of your tax Taxon Wages. ~ - - return. ~ ". ~ ~ Box 8. Shows substitute payments in lieu of dividends or tax-exemptinterest received by ' ~ - " Boxes 1' and 2: Report rents from real estate on Schedule E (Form 10401. If you provided - your broker on your behalf as a result of a loan of your securities. Report on the "Other - . ~ - .significant services to the tenant, sold real estate as abusiness; rented personal property as a ~ income" line of Form 1040. - business, or you Viand your spouse elected to be treated as a qualified joint venture, report bn Box 9: If checked, 55,000 or~more of sales of consumer products was paid td you on a • Schedule ~C or GEZ IFoim 10401.For royalties on timber, coal,. and ironore, seePub. 544. buy-sell, deposit-commission,. or other basis..A dollar amount does not have to be shown. ,. " ~ 'Box 3.Gerierally'; report this amount pn the "Other income" line of Form 1040 andidentify Generally, report any income`-from your sale'of these products on Schedule C or C-EZ - ' ~ ~> the'paymeni: The amount shown may be payments deceived as the beneficiary of a deceased (Form 10401. -' employee, prizes, awards, taxable damages, Indian gaming profits; paymehts from a former Box 10. Report this amount online 8 of Schedulef (Form 1040E ~ - ' emplbyerbedauseyou are serving in theArmedForces dr the National Guard for a period - 'Box l3. Shows your total compensationof exgess~golden;parachute payments subject . of 30tor fewer days; or other taxable income: See Puti. 525. Af. it is trade or business ~ to a 20%-excise tax. See the Form 1040 instructions for where to report. ' income„report tliisamount on Schedule C,. C-EZ, or F (Form 10401. ~ ~ Box 14. Showsgross proceed@.paid to an attorney inconnection. with lega6 services: ~ - - ., Box 4..Showsbackup withholding ~or withholding. on Indian gaming profits. Generally, a Report only the taxable part as income on your return. ' payer must backup withholdnt a 28%.rate if you did not furnish yqurtaxpayer Box 15a: May showcurrent~year deferrals asa nonemployee under a nonqualified - identification number..See Form N/-9, Request for Taxpayer Identificatioh Number and deferred compensation INODC) plan that is subject tq the requirements " .Certification; and Pub.'505, for more information. Repgrt this amount on your income _ of section 409A, plus any earnings on current and prior year deferrals. - . 'tax return as tax withheld. - ~ ,Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the . Box~5. An'amountin this box means thefishing. boat operator considers you self-employed. requirements of section.409A. This amourit is alsoindluded in box 7 as nonemployee .Report this amouritdn SdheduleC. or GEZ (Form.. 10401. See Pub. 334. -- ~ ~ compensation.. Any amount included in box T5a that is curreritly taxable is also included - Box 6'. For individuals, report pn Schedule C or C-EZ (Form 1040). in this box. This income is alsosubject to a substantiaF additional tax to be reported on Box 7. Shows nonemplbyee,compensation_ If you areih the trade or business of catching Form 1040. See "Total Tax" in the Form 1040instructions. fish,box 7may showcash you received for the sale of fish. If payments in this box are ' _ ,. - -' .. Boxes 16-18. Shows state or local income tax withheld from thepayments. .Page 1 of 1 -