Tui Munday OUTSIDE EMPLOYMENT STATEMENT
MIAMFD
~ For Full-time County and Municipal Employees
FULL TfME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING iN OUTSIDE
EMPLOYMENT MUST FlLE AN ANNUAL DISCLOSURE REPORT BY .IDLY
OF
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2
11 Disclosure for
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1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2- TaX Year Ending:
THE MIAMI-DARE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee
~uniapai Employee of: C.~ ~ ~ O~ V~ ~ ~~ ~J
Posfion Title:
CountyMluniapal Department: ~ County/Munic;pal Division:
if your home address is exempt from public records rsuant
~ Work Telephone:
to Florida Statutes § 119.07, please check bane: S (o ~- 3 ^ . ~ p~0
Mailing Address (Str~set Name and Number} Apt. #
City State Zip Code.
Please fist the sources of ou~ide employment, the nature of the work and the amounts of money or other
compensation you n3ceived. if continued on a separate sheep please check here: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outside income Pertormed Compensation Received
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i hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signatu~ taco Disclosing Date Signed
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