Gary Held December 2009 MIA, 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 Th ?
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1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2- 11.1(K)(2) OF Tax Year Ending: 1 /
THE MIAMI -DADE COUNTY CODE.
Name: La / First Middle
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Filing as a (check one): ❑ Miami -Dade County Employee
[ J1.iunicipai Employee of: /i / 6 - e - ,..---e--4_,
Position Title:
E5
County/Municipal Department: County/Municipal Division:
£, 4.9 DJ 7
if your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ❑ 3 of - 4, - 7 ' 7c)
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
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: n
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. c-' Ti
Signature of Pe Disclosing Date Signed '�
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