Elise Spine Taylorrr ,. _.
MIAMfDADE
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ou~';~~I~IIPLOYMENT STATEMENT
® For Full-time L~ou~r'~n unicipal .Employees
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UTSIDE
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES [[~ ~~ F~ ~' / ~
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EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
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2 DisGlOSUre fOr
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1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)( Tax Year Ending:
THE MIAMI-DARE COUNTY CODE.
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Name: Last First Middle
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Filing as a (check one):. ^ Miami-Dade County Employee
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Municipal Employee of: ~ C1i" M~GM/ ~~C(Gh
Position Title:
i~e~-ecf~'ve.
County/Municipal Department: County/Municipal Division: ,
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If your home address is exempt from public records pursuant Work Telephoner
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toFlorida Statutes § 119.07, please check her>3:~ fC~~.
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Mailing Address (Street Name and Number) Apt. #
City State Zip Code
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Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. !f 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 correct statement. -
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Signature of Person Di ing Date Si ned
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