Joseph Clement Bacallao4 - r
MIAM OUTSIDE EMPLOYMENT STATEMENT
For .i=ulhtime County and Municipal Employees
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~LOYd~ti' tYN/ST FIt.E AN MB~JAZ. 019Ct!0~ t~PORT BY .q.~..Y
1ST OF E~LCF! YEAR W ~ VIrtiH SECTION 2-11.1(Kj(2) OF Disdosur8 for
Tax Year Ending: ~~ l ~
7HE MtAW-Db40E COl)NTY CODE.
Name: La.4t
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Fiiing as a (check Otte): ~ Mi~--i-Dade Coto~ty Errlploy
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Position Title:
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CamtYlMunicipal = MAurac~ Division:
Cotmty
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tf your ttortie address is exempt from pttWiic records ptrreuettf Work Telephone:
to Plaids Statutes § 119 07, please dteolr tterar: ^ `? 8~ e 'Z / 9 - 7~3
Mailing Address (Street Name artd /Wur~berj Apt. ~
~ 1 ~ ~ s-~ sr ~ 3 Z ~--
~Y State Tap (',ode
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Please 8st the of outside employment, the nature ~ the work and ttte aritottrds of money a atlier
oorron yru naoeived. If aid on a SeparehB sheet; please check l>er+e: ^
Name slid Addntss of the Souroe ~ Nature of the Work Antairrt of iYlonetr or
OutsWe income Perforated Compensation Reoeimed
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( hert~y sw~ (Or ~ fh8t ilia d inf~TTiBhOn is 9 trite slid correct ertserit.
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