James A. Martell MIAMFDADE 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: 2-� t THE MIAMI-DADS COUNTY CODE.
Name: Last First Middle
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Filing as a(check one): ❑ Miami-Dade County Employee
[] Municipal Employee of:
Position Title:
County/Municipal Department: County/Municipal Division:
As h
!f your home address rs exempt from public records pursuant Work Telephone:
to Florida Statutes§ 119.07, please check here: ❑ 36 Cv 7
Mailing Address (Street Name and Number) Apt.#
9 Zo 0 S``4j I (e T^U_A�
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 R&eiv#g
[57( 51;VtLLA ^ Ft.
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I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
11 �'�N �
Signature of Person Disclosing :`,' ' S. - ''j `° Date Signed
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