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OUTSIDE EMPLOYMENT STATEMENT c~T ~`
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For Full-time County and Municipal Employees (~~
FULL-TIME COUNTY AND MUNfCIPA1_ EMPLOYEES ENGAGING IN OUTSIDE
'EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
1S7 OF EACH YEAR IN ACCQRDANCE WITH SECTION 2-11.1(K)(2) OF .Disclosure for ~9 /~
TaX Year Ending: LAW
THE MIAMI-DADS COUNTY CODE.
Name: LQast First Middle
Filing as a (check one): ^ Miami-Dade County Employee
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~Munidpal Employee of: ('~ ~ a~w--, g e.Gc_C.~- P~ ~ c. UP
Position Title:
County/Mt~ntd I Department• CountylMunidpal Division:
If your home address is exempt from public reoorris pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ^ ~ D- _ 6 ~ 3 _ ~ ~
Mailing Address (Street Name and Number) Apt, #
(+ o o wt'jS Nn -.~ TOb~ '~-tt~r1~ N' (~
City State Zip Code
~1:tw,.,~: , g~ ~ 33.13 I
Please list the sources of outside employment, the nature of the work 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
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l hereby swear (or affirm) that the aforesaid information is a true and correcK statement.
Sign re o Pe n D' i _
~ Date Signed
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