James A. Martell OtJT~I~DE EMPLOYMENT STATEMENT
MIAMFDADE
® For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY .IULY DISCIOSUiB fOr
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1ST OF EACH YEAR IN .ACCORDANCE WITH SECTION 2-11.1(x)(2) OF TaXYearEnding:
THE MIAMI-DADE COUNTY CODE.
Name: Last First Middle
'Filing as a (check one): ^ Miami-Dade County Employee
^ Municipal Employee of.~l •~1 ~ F ~~ ~ ~ ~~~~"'
:Position Title:
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CountyMlunicipal Department: County/Municipal Division:
~; If your home address is exempt from public records pursuanf Work Telephone:
to Florida Statutes § 119.07,. please check here: ^ 3 O ~' ~ 7 3 - 7 b ~
Mailing Address (Street Name and Number} Apt. #
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Cry State Zip Code.
yl'1 (rA-~~~ I ~ fZ 3 3 i 'a 7
Please List the sources of outside employment, the naturie of the work and the amounts of money or other
compensation you received. if continued on a separate sheep please check here: ^
Name and Address of the Source of Nature of the Work Amount of AAoney or
Outsideancome Performed Compensation Received
1 hereby swear (or affirm) that the aforesaid information is.a true and correct statement.
Signature of Person Disclosing Date Signed
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