Gary Held 2010 I -
MIAMED' 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 D��
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2- 11.1(x)(2) OF Tax Year Ending:
THE MIAMI - DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): n Miami -Dade County Employee
aMunicipal Employee of: �' ' >-r-4
Position Title:
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County/Municipal Department: County/Municipal Division:
If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here:
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
)i 12 41 F� X19
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. -11 o
Signature o f Pefion Discl 'ng Date Signed
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