Ricky D. Falls 2015 MIA FDADE
OUTSIDE EMPLOYMENT STATEM ;;NJr(N 28 txi 2.
For Full-time County and Municipal Employees
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FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE .
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure for � /��20 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
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Filing as a(check one): ❑ Miami-Dade County Employee
Munidpal Employee of: C- i 17 0 F /r ,/' P l ) = C.
Position Title:
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County/Municipal Department: County/Municipal Division:
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If your home address is exempt from public records p rsuant Work Telephone:
to Florida Statutes§ 119.07, please check here: 305 ` 73- .7 / 3
Mailing Address (Street Name and Number) Apt.#
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City State Zip Code
/4144 1 ee.a..64 �-
3309
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: n
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
Zoci1 G o UP Li ) 1 I D
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l hereby swear(or affirm)that the aforesaid information is a true and correct statement.
Signature n D' losing n Date Signed 16
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