Andrea Palacios (2) ~
M~AMI~DADE OUTSIDE EMPLOYMENT STATEMENT ~ ~~,
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~ For Full-time County and Munlclpal Employees
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iFULL TfME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE ~ G
~APLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
~1 ST OF EACH YEAR MI ACCQRDANCE WITH SECTION 2-i 1.1(I~(2) OF_ i
DISCi08ur@ foi /,
Tax Year Ending: o(~/
THE MW~AI-DIME COUNTY CODE. ~
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~t+la First Middle
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~FiNng as a (c~edc one): ^ Miami-O~ade County Emp(o y~ee
V^/Municipal Employee of:
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;Position Title:
' 1rVlQ- ~- ( N i GIGS
+Courrty/Municipal DepartmenE:
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~ CotiMy/Municipal Division:
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rf your home address is exempt tram public neco-ds pursuant
ro Fkxida Statures § 719
07
please check here: ^ Work Telephone:
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. _ CQ~3 _ ~ ~.
~ Mailing Address (Street Name and Number) . ; - Apt. #
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City _ State Zap Code
S ~e ~ N s ~- X333
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i Please list the sources of outside employment, the nature ofi the work and the amourrts of money or other
compensation you received. If oa-tinued on a separate sheset, please check here: ^ _
Name and Address of the Source of
Outside Income Nature of the Work
Performed ; Amount of Money or
Compensation Received
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~ 25000 = 30; LYE
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1 hereby swear (or affirm) that the afon~aid infomration is a true and oon~ect statement.
Sig of Person Di ! pate ~gr~
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