Javier Matias MIAitI OUTSIDE EMPLOYMENT STATEMENT
® For Full-time County and Municipal Employees
FULL TIAAE COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY .JULY Disclosure for f
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(1)(2) OF Tat Year Ending:
THE MIAMI-LADE COUNTY CODE.
Name: Last First Middle
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Filing as a(check one): ❑Mlami-Dade County Employee
❑Municipal Employee of: RA .i4C
Posi ' 'le:
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County/Municipal Department: H/AM 1 �� County/Municipal Division:It . ..* .�
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If your home address is exempt from public record, ant Work Telephone:
to Florida Statutes§ 119.07, please check here. �
Mailing Address (Street Name and Number) Apt.#'1
City � State Zip
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Please list the sources of outside employment,the nature of the work and the amounts 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 swear affiT hat the aforesaid information is a true and correct statement.
Sig Pepf Person I= Date 'g
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