Miguel M. Romero MIAMEDADE 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(x)(2) OF Tax Year Ending: /
THE MWAI-DADS COUNTY CODE.
Name: FirVic( Middle
Filing as a(check one): ❑ Miami-Dade County Employee
units al PIoY
e Em ee of:
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Position Title:
1""ae
County/Municipa Department: County/Municipal Division:
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If your home address is exempt from public records pursuant Work Telepho :
to Florida Statutes§ 919.07, please check here:❑ 03
Mailing Address (Street Name and Number) Apt.#
700 &OLVL�LA�
City State Zip Code
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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
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I hereby swear(or affirm)that the aforesaid information is a true and correct statement. w —�
Signature of Pe n Disclosing Date Signed
10128!00