Judy Hoanshelt MIAMID OUTSIDE EMPLOYMENT STATEMENT
For Full -time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE c'-
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure for c....
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2- 11.1(K)(2) OF Tax Year Ending: 20
THE MIAMI-DADE COUNTY CODE. -
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Name: Last First Middle 7
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Filing as a (check one): [J Miami -Dade County Employee F
-2 Municipal Employee of:
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: ❑
Mailing Address (Street Name and Number) Apt.*
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City State Zip Code
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 swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of - : • n Di •: ng Date Signed
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10/18!00
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