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MI AM 3 OUTSIDE EMPLOYMENT STATEMENT
MINI For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Di sc l osure f
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF
THE Mime-DADE COUNTY CODE. Tax Year Ending:
Name: Last First Middle
Filing as a (check one): E Miami-Dade County Employee
,2 Municipal Employee of: M ti ( e-ie-.4
Position Title:
0 rel C4 As SOC- i
County/Municipal Department: County/Municipal Division:
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if your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: 30 &-) 3 7 giff t t
Mailing Address (Street Name and Number) Alt #
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City State Zip Code
$16-Yck-C44 ta— / /o
Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received, if continued on a separate sheet, please check hem: E.
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement,
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Signature f Person Disclosing Date Signed
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