Echo R. Herman MIAMFDADE OUTSIDE EMPLOYMENT STATEMENT
® I 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(x)(2) OF Tax Year Ending
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: cikq a M'"4:t� e,N
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 Worts Telephone:
to Florida Statutes§ 999.07, please check here:❑ (305) (O-73 —100 v x ka t otg
Mailing Address (Street Name and Number) Apt.#
Z°l RVJ 1-J- AVt , }tip- '11 a--
City State Zip Code
�FL 331 aY
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
S}ella Dot at k%Cm<Gwlery Sa I es D:'\0 0
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I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
Si nature of Person Disclosing Date Signed
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