Tui Munday 2010 MIAM OUTSIDE EMPLOYMENT STATEMENT
For Full -time County and Municipal Employees
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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: 0 1 r a
THE MIAMI -DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): ❑ Miami -Dade County Employee �+
® Municipal Employee of: �•-�si o. h..i Q► 1„•' 14
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: ❑ 30.5 (o 4 3- -SS V
Mailing Address (Street Name and Number) Apt. #
Tb. 11 3Y 110 It.4a-
City State Zip Code
eW Pte. %'e°-c --4a E L. 3 R 11 42 )
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: ❑
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 nfi) that resold information is a true and correct statement. -"
Signature of Person isclosing Date Signed
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