Daniel Antoine ■
MIAMIDADE 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: 4 ' 0 /1
THE MIAMI -DADE COUNTY CODE.
Name: Last First Middle
A/1
Filing as a (check one): n Miami -Dade County Employee
ailluniapal Employee of: 4 41/ 1 " - Z41 � L
Position Title:
, V /5 7
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: IL
Mailing Address (Street Name and Number) r---� Apt. #
• 2 �. > 6 i, 7
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: n
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
G
N//1- /v/ff N/4_
•
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing Date Signed
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10/28!00