Maurice Goodbeer
•
"'®~ SOURCE OF INCOME STATEMENT
Please Print or Type
Name:
Mailing Address:
CityJState/Zip:
First Name Middle Name Initial t.ast Name
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Disclosure
For Tax Year
Ending: ~
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Social Security Number: ~~~ - a ~ ' ~~~`~
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving:~,~~~ ~ j~
Department where employed:
Work Address:
Term or Employment
Began on: ~ CSC- /~
If your home address is exempt from public records pursuant to
Florida Statutes § 119.07 please check
Please list below in descending order with the largest source first, the name, address and
principal business activity of every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet, check here: ® J
Name of Source of Income
Address Description of the Principal
Business Activi
57"~rz~~ T•~d,~/~ s Cae~or~- i~ f ~~~ 35'~a t'~ 3 3 a 3 ~ sc~~~i~v ~'ac-fr~u~t s'
Z hereby sear ~or/affirm)1that the aforesaid information is a true and correct statement.