Richard M. ClemensCOPS"
MI OUTSIDE EMPLOYMENT STATEMENT
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- For Full-time County and Munlclpal Employees
FULL-TINE COUNTY q(~ MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST RLE AN ANNUAL DISCLOSURE REPORT BY JULY DisC108U[@ fOi
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending: ~~1 ~
THE MIAMI-DARE COUNTY CODE.
Name: Last First Middle
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FiFing as a (check one): ~ Miami-Dade County Employee
~Muniapal Employee of: M ~ +4m ~~'1'~-c.l+
Position Title:
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CountylMunicipal Department: County/Municipal Dnrision:
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tf your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ~' ~~,~, ~,~ .3 __-7 ~ ~ ~
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
Please list the sources of outside employment, the nature of the vuork 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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I hereby swear (or affirm) that the aforesaid information is a true and correct statement
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