John Carl Clemens IAMw
~~ OUTSIDE EMPLOYMENT STI~-TEMENT
For Full-time Coun
ty and Municipal Employees
FULL-TIAAE COUNTY A(~ MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
1ST OF EACH YEAR tN ACCOROMWCE WITH SECTION 2-11.1(K)(2) OF
THE MIAMI-DiADE COUNTY CODE.
i DisClOSUre for ~~
Tax Year Ending: ~G~°1
Name: Last First ,' Middle
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FiNng as a (check one): ^ Miami-taade County Employee
® Munidpal Employee of ~~~ ~ ~ /~cA
Position Title: ~'
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County/Munici
pal Department: County/Muniapal Division:
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!f your home Baldness is exempt imm public neco-ds pursuant
to Florida Statutes § 119.07, please check here: ® W i rk Telephone:
3~5 6 - 7 oa
Mailing Address (Street Name and Number) jl , ,qpt, #
11
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City ~ State Zip Code
~~
Please list the sournes of outside employm~t, the nature of the w~ortc and the ama~lnts of money or other
compensation you received. licontinued on a separate sheet, please check here:
~~
Name and Address of the Source of
Outside income Nature of the
Perfom~r 1Nork
ed~ Amount of Money or
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true ~~ correct statement.
Signet osing - ~' Date Signed
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