Jeffrey A. Singer MIAMIDAQE 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 ?,p
1
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending'
THE MIAMI-DADE COUNTY CODE.
Name: Last First Middle
Filing as a(check one): ® Miami-Dade County Employee 1 `
Municipal Employee of: V �(`
Position Title:
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County/Municipal Department: > ,� J County/Municipal Division:
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If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes§ 119.07, please check here:❑ 3 a S ' 6'-73—7.�7
Mailing Address (Street Name and Nu ber) t✓ / Apt.#
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City State -331 Zip code
Please list the sources of outside employment,the nature of the work and the amounts.of money or other
compensation you received. Of 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 afo il information is a true and correct statement
Signature of Person Disclosing Date Signed
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