John Gershman ~~T~I~QE ElVl~L01(MEhIT STATE~IIIENT
MIAMhDADE~ Far Full-time County and Municipal Employees
FULL TI{UIE COUNTY AND MUNICIPAL ~EMPIOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY .JULY
1ST OF EACH YEAR IN ACCORDANCE WITFI SECTION 2-11.1(x)(2) OF Disclosure for
T~ Year Ending: ~ ~ `'~ ~
THE MIAMI-DARE COUNTY CODE.
Name: last
Cis ?~/y First 1
~ ~H~ Middle
(~
Filing as a (check an®): ^ Miami-Dade County Emp{oyee
~IVlunicipal Employee of: ~f ~~~ f,~:'~ cif
Position Title:
County/Municipal Department: ~ ntylNlunic;paf Division:
Gou
,~,,+
y~
If yoerr home address !s exempt from public records pursuanf Work Telephone:
to Florida Statutes § 118.07, please check here: ^ ~~~,-~ ~~ .~ ~~'~ /'
Mailing Address .(Street blame and lV~arr2ber} Apt. #
Cky State dip Gode.
~~ ~3`'~1"~iJ ~~ ' 3
Please list the sources of outside employment, the nature of the work and the amounts of money or other
carnpensation you received. !f continued on a separate sheep please check here: ^
Name and Address of the Source of
Out$ide income Nature of the Vilorls
Performed Amount of Alloney ar
Compensation liecenred
~.~/f~l~-a.J ~ ~ ~ ~
=
ut
••~ t°5
Y-'
;:
~;; ~
~ .
_ _ ~ ,,
. ~ ~`
..y, i
-rt ••
.~
iY! .~.
1 hereby swear (ar affirm) that the aforesaid information is a true and correct statement.
Signatu Person D" losing n
ed
Data Si
g
Q
r
~
oG./ ~~
C /
~/.~~-
10126100