Donald M. PapyMI
ADE OUTSIDE EMPLOYMENT STATEMENT
~ For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF
THE MI
M
D Disclosure for
Tax Year Ending: Z~~
A
I-
ARE COUNTY CODE:
Name: Last ~
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Filing as a (check one): ~ Miami-Dade County Employee
~~Municipal Employee of: C /dJ ~ ~''°"""'~ D~tiy1
Position Title:
1
Coun
ty
/Municipal. Department: County/Municipal Division:
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!f your home address is exempt from public records pursuant Worts Telephone:
to Florida Statutes § 119.07, p/ease check here.' ^ 3d 5 , C~73 7S-'7v
Mailing Address (Street
N
ame and Number) Apt. #
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Clty 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. #continued~on a separate sheet, please check here:
Name and Address of the Source of Nature of the Work Amount of Money or
Ou
tsi
d
e Income Perform
d
e
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and con-ect statement v
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Signatur erson Disclosi
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Date Signed
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