George Varon MI A M FDADE
®.~9TSII~E:EMP~OYME~6T STATEt~iE(NT
I ~ For Futl-time County andMurticipat'.Employees
1fULL-TIME COUNTY.AND MUNICIPAL EMPLOYEES ENGAGING 1N OUTSIDE °
EMPLOYMENT MUST, FllE AN ANNUAL DISCLOSURE REPORT BY .)ULY
OF
1(x)(2)
CTION 2-11
S .Dis~iOSUte for ,~ DO
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1ST OF EACH YEAR. IN ACCORDANCE WITH. ~~ Yeafl
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'eTHE NiIAMi-DADS COUNTY CODE.
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Name: _ last ~
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First
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Filirig as a (check one): ^ Miami-Dade County Employee • Q
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ee of:
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CountylMunicipai Department: County/AAu icipai Division:
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!f your home address is exempt from:publc recoNs ursuanf
Iao Florida Statutes.§:.919.07, please check here:
t Work Telephone:
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'Mailing Address (Street Name and Number] -At~• #
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City a 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
f compensation you received. If continued on a separate sheep please check here: Q
'' Nettie and Address of the Source.of
f ~Out$ide income • Nature of~the~Work
Performed Art~ountof Adoney or
Co ensation :Received
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~,1 hereby swear (or afrirm).that~thegaforesaid.information is a'.true and correct•statement. ~; c,,i '°'
°SignatureofPerson scl sing
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~ DateSigned
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