Kimberly a. McCoy IAMFDADE OUTSIDE EMPLOYMENT STIa-TEMENT
~ For Full-time County and Municipal Employees
FULL TIAAE COUNTY AND MUNICIPAL EN~LOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(ICj(2) OF DISCIOSUre fOf~~~~j
Tax Year Ending' ~y -
THE MIAMI-DARE COUNTY CODE.
Name: Last
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FiFing as a (check one): ^ Miami-Dade Courtly Employee
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1~Muniapal Employee of: ~ ~ vU -< < ~~C~~ ~ ~
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County/Municipal Department: CountylMuniapal Division: ua o
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If your ho address is exe from public records pursuant Wor1c Telephone:
to Fior-~ statures § T~s.o~, please ~hea~ nets: ^ ~5 `7 3 -1 ~7 'b
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
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Please list the sources of outside empk~rmeM, the nature of the work and the amounts of rrloney or other
compensation you received. !f oorltrnued on a separate sheet, 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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I hereby swear (or affirm) that the resaid information is a true and correct statement.
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