Dessiree Antonia Kane MIAMI- E 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 1 st of Disclosure for
each year, in accordance with Section 2-11.1(k)(2) of the Miami- Tax Year Ending:
Dade County Code.
Last Name:
First Nam Middle Name:
t ��i
Employee ID#:
Filing as (check one) ❑ Miami-Dade Co. Employe
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❑ Municipal Employee of.
Position Title:
County/Municipal Department: County/Municipal Division:
If your home address is exempt from public records Work Telephone:
pursuant to Florida Statutes § 119.07, please seethe
note on the following page and check here: ❑ > Col 5 -7(Q
Mailing Address (Street Name and Number) Apt. #
L-I (_0 a5 ku?'OrN tc>�
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
S�
PID FL-02A O
hereby swe r (or affirm) that the aforesaid igfgrm op i .tre and correct statement.
Signature of lerson ' closing aid 61 Nnr 110Z Date Signe
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COE,rev 4120 10