Daniel Antoine 2009 r
IMAM OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
FULL-TIME COMMAND MUNICIPAL EMPWYEES ENGAGING IN OUTSIDE
B/PLOWENI MUST FILE AN ANN11 DISCLOSURE REPORT BY JULY Di sc l osure for
1ST OF EACH YEAR IN ACCORDANCE WM4 SECTION 2-11.1(0(2) OF Tax Year Ending: zoff
THE MIAMI-CADE COUNTY CODE.
Last First
W I Middle
Filing as a (check one): [3 Muni-Dade County Employee
EiMunicipal Employee at K/07/77/
Position ThI-
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County/M,iicipal 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: Er
Mailing Address (Street Name and Numbed Apt. #
AO /
City State Zip Code
Aim'/ /soya 3 3J, 7
Please list the sources of outside employment, the nature of the WO* 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
Si —11 Person Disclosing Date Signed
`77
411
10128100
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