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Clara La Rosa 2014 MIAMI-DADE OUTSIDE EMPLOYMENT STATEMENT COUNTY For Full-time County and Municipal Employees Full-time County(including Public Health Trust)and municipal employees engaging in outside employment must file an annual disclosure report by July 1st of each year,in accordance with Section 2-11.1(k)(2)of the Miami-Dade County Code. Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial 2014 La Rosa Clara Mailing Address—Street Number,Street Name,or P.O.Box 8031 Abbott Avenue # 17 City,State,Zip ID Number Miami Beach, Fl 33139 If your home address is exempt from public records pursuant to Florida Statutes§119.07,please see note on the following page and check here.❑ Filing as an Employee(check one) County/Public Health Trust In Municipal City of Miami Beach (Municipality) Department Division Office of City Clerk Position or Title Work telephone Office Assistant III (305) 673-7411 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,check here. ❑ Name and Address Nature of the Work Performed Amount of Money or of the Source of Outside Income Compensation Received Perfect Gifts Retail Sales $10/hr. I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: ❑Hardcopy ❑Electronic Copy Signature o Person Disclosing _'.,Jr.l ti I 65-A1-01S-Date sig d •6 t; Nir!101 $ s OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials: 138_01-22 COE 2015