Antwan L. Terry 2010 MIAMFDADE 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 / /i
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2- 11.1(K)(2) OF Tax Year Ending: ( l�
THE MIAMI -DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): 1 1 Miami -Dade County Employee
Municipal Employee of: c ;
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: n 1c di0 v I
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
330 s A-(
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: Ti
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. f
Signature of Person Disclosing Date Signed
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