Tui J. Mundayr
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 1
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending: f
THE MIAMhDADE COUNTY CODE.
Name: Last First Middle
Filing as a(check one):' ❑ Miami-Dade County Employee
® Municipal Employee of: -�-y off' IM �` vim•.. ; 'C-
Position Title:
County/Municipal Department: County/Municipal Division:
if your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes 919.07, ease check here: U
. � � � 3 S-co�,3 --�-o 0o
Mailing Address (Street Name and Number) Apt.#
� O. �jox o l �-la
City State Zip Code
VV-\ I` ter✓-. ; �� L= L. 3 I I
Please list the sources of outside employment,the nature of the work and the amounts of mCley tether
compensation you received. if continued on a separate sheet, please check herb: ❑ N
Name and Address of the Source of Nature of the Work Amount of-Morfq or,-
Outside Income Performed Compensation R�ive�.
� -7UO N
M)
I hereby swear(or affirm)that the aforesaid information is a true and correct statement.
Signature of Person Disclosing Date Signed
,0126=