Chuck A. Perony 2014 •
I
MIAMII•iOADE 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/ Mal
2014 Pe r6ov v t&
Mailing Address—Street Number,Street Naa�mee,or P.O.Box q
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h►. � p � ID Number Aft. PCt C 3tiqi iJ 7
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)
indij it gag_Cht
®County/Public Health Trust Municipal
(Municipality)
Department Division
Position or Title Work telephone
, VI y
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 M ney or
,off the Source of Outside Income Compensati Received
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I hereby swear(or affir -at the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
❑Hardcopy
❑Electronic Copy
S,natur- , 'ers. 1 sciosing
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Date sign.d LE 1 1 .,11 CI f r z
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_01-22 COE 2015
.
A