John B. Gresham IAM OUTSIDE EMPLOY MENT STATEMENT ',
Fort=u~t-time County+ a ,
nd Municipal Employees
FUl1: TIME COUNTY AND MUNICIPAL EAAPLOYEES ENGAGING iN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY I JULY j
DisciOSUre for
9ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-1,1.1(K)(2) OF T;~ Year Ending' a2 ~~ ~
THE MIAMI-DARE COUNTY CODE.
Name: Last First I ; Middle
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Filing as a (check one): ^ Miami-Dade County Em ~
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Municipal Employee of:l ....
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Position Title:
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CountyMlunicipal Department: - I ' County/Allunicipal Division:
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If your home aafdress is exempt from public -eco~Ms rsuarif
~ Work Telephone:
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to Florida Statutes § 119.07, please check here: ~ 3~„~73 _. 76 3
Mailing Address (Street Name and Number} Apt. #
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Cky I~; State Zip Code.
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Please fist the sources of outside employment, the nature of~the work and the amounts of money or other
compensation you n3ceived. if continued on a separafe sheep:please check hen4: ^
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Name and Address of the Source of Nature of the Work Amount of Money or
Outside income Performed Compensation Received
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1 hereby swear (or affirm) that the aforesaid information is a tine and correct statement. rn
Signat P n D' losi g ~j Date Signed
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