Andrea L. Palacios 2010 MIAM 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: 010 I (
THE MIAMI -DADE COUNTY CODE.
Name: Last First I Middle
rPik( acI0S drew
Filing as a (check one): ❑ Miami -Dade County Employee , ,�
El Municipal Employee of l ;! 00 1 t am t 3QQc.h
n Position Title: / � "
ira1Ak SIJC.IV e .e /1/U lC I GN j
County/Municipal Department: CrWINai County/Munic Division:
- t I ('JQocki I�'ol is e, De ZIUJ.esti DM IUrC
If your home address is exempt from public records pursuant Work Telephone: v
to Florida Statutes § 119.07, please check here. ❑ ( 01 - C■1 tX 56 W
Mailing Address (Street Name and Number) Apt. #
S 3 I i\3d &vAus2.
City State Zip Code
@O(k1 9 (aNdIRE FL 3333
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
utA4I rf l ed weft ux_ X100 otv�.e.. Oc cu ppOC,y/ 4�pprc rnettely
X$Iq fJ • a t IQ (,Q., Greclasure V r,�'ica -trn� �- fo 1 Z
Phoenix ( R z g5O50 QN y
C") g rn
•
I hereby swear (or affirm) that the aforesaid information is a true and correct statement. �'
o -•i
Signatl of Person D' • Date Signed
ova))
,029100