James A. Martell 2010 MIAMIDADE 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: Ot I
THE MIAMI -DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): U Miami -Dade County Emplore
Municipal Employee of: c F 1 IAA t .13 j-1
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 Telephohe:
to Florida Statutes § 119.07, please check here: I { 313C- ( 3 - 7 6 3 0
Mailing Address (Street Name and Number) b G 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. ff continued on a separate sheet, please check here: I f
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. ;=� 4-
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Signature of Person Disclosing Date Signed
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