Gary Held December 2008 MIAM FOAOE OUTSIDE EMPLOYMENT STATEMENT
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 Disclosure for
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2 - 11.1(K)(2) OF Tax Year Ending: • 2
THE M{AMI -DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): L Miami - Dade County Employee
unicipal Employee of: /' j��j'"'• 13
Position Title:
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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: E
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 employment, the nature of the work and the amounts of money or other
compensation you received. if continued on a separate sheet, please check here: C
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. -^ W
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Signature of Perso • ." . losing Date Signed
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