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John Clemens IAMw~ 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 Disclosure for 1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending' c~Gxx'1 THE MIAMI-DADE COUNTY CODE. . Name: Last First Middle ~~~~'/v'~ ~r„~ ~~ ~ ~fj~ ~- Filing as a (check one): ^ Miami-Dade County Employee ® Muniapal Employee of: ~ 9~'ji ~~ %~ dPrr~ i (~c°AJd''~'~~ Position Title: P e ~~~ -~;c . ~~~L ~ County/Municipal Department: CountyJMunicipal Division: !f your home address is exempt from public records pursuanf Work Telephone: to Florida Statutes § 119.07 please check here: ® . , ~~ 6 ~_ 7 ~ Mailing Address (Street Name and Number). Apt. # t~ ~ ~ I Sc..~ ~ t ~ A u ~" City State Zip Code r.~f M i ~ 31 ~ Please list the sources of outside employment, the nature of the work and the amounts of money or other compensation you received. if 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 Perf omned Compensation Received y~ J ? 6131 SC.~} [ 14 f1ut: f'(i~,~~~ ~~ ~,1 `~3 1 hereby swear (or affirm) that the aforesaid information is a true and correct statement. Signat isclosing Date Signed j ~- d'~' ~-©)Cl ~ ~ 1028!00 f, a ~z ~?~,=k~s i~~ i, o