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Richard M. Clements~;~ ~- ~~ ... _ I ~ ~: OUT'SIDEEMPLOYMENT STATEMENT Mr~~ - For Full-time County and Munlc~pal Employees FULL-TIME COUNT1f AND MUNICIPAL EMPLOYEES ENGAGING `IN OUTSIDE EMPLOYMENT NNST FILE AN ANNUAL DISCLOSURE REPORT BY .JULY Di8C10SU1'e foi 1ST`OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF Tax Year Ending: ~©`~ l7 THE'iMIAMFDRDE COUNTY CODE. Name:.Last _ First ,Middle' .. .. FiNng as a (check one): ~ Miami-Dade County Employee i~ pal ployee of: Position Title: ^-~ County/Munici p al Department: CountylMunicpal Division: - - -- ~ri~.~ cE. '~-~~G.-~'1 t-~ ~ ` ~ ~1 ~ ~4~ t, .~Ivi3 F ST1 t7 c~=}Z o~.,S If your home addr:3ss is exempt from public records pursuant Work Telephone: to Florida Statutes § 119.07, please check hers: ~" ~~ ~ ~ ~ ,-3 ._ -~ ~ ~ Mailing Address (Street Name and Number) Apt. # City State. _ Zip Code Please list the sources of outside employment, the nature of the wofk and the amounts of money or other compensation you received. tf continued 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 r~ ~~~, M ~ cX ill L~.sv i t..i+LLtZ: [. ~ ~ ~ V ~ 1 ti S ~ CJ~-'IW 6~.. G r ~- ~.iS'r~l. ~ y iJ SF'.Y~` '~\v'1~ - 4 C~O G ~ ~ \\3~SG i~3 ~ ~1 .11~ ~ 1..~ . h'C~l'~~L , ~ UL.i ~ O p, ,- ~ . ~.v,oo~. r( hereby swear (or affirm) that the aforesaid information is a true and correct statement. . , Si nature of Person Disclosing N Date Signed ~'~.^,.vti.~ ~~~~ 1 C7