Clifford D. Beck ,
MIAMFDADE
~ OUTSIDE EMPLOYMENT STATEMENT
® ~ For Full-time Coun and Munici al Em 7o ees
tY P P Y
FULL-TIME COUNTY AND MUNfCIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY pisclosur6 for
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF Tax Year Ending: 2 a~
THE MIAMI-DADS COUNTY CODE.
Name: Last ~ ~ Fi ~
~~ Middle
Filing as a (check one): ^ Miami-Dade County Empl ee
Muniapal Employee of: ~~ / f
Position Titl '
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County/Municipal Department:
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~ Cou, /Municipal Division:
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if your home address is a empt from public records p uant Work Telephone:
to: Florida Statutes § 119.07, please check here: ~ ~ ~ ~ - 6 ~ 3 - 7 ~3~
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
~~ ~~d~~~ ~t ~ 3331 ti.
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 ~ ~ Nature of the Work Amount of Money or
Outsi
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d
e
ncome Performed Compensation Received
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f hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signat o e Disclosing Date Signed
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