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Luis Sosa Outside Employment Statement 2016MIAMI•DADE OUTSIDE EMPLOYMENT STATEMENT tm 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 2016 Sosa Luis A Mailing Address — Street Number, Street Name, or P.O. Box 11155 sw 138 st City, State, Zip Miami, FI 33176 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. ❑ Filinq as an Employee (check one) County ❑ Public Health Trust Municipal City of Miami Beach (Municipality) Department Division Building Plumbing Position or Title Employee ID Number Work telephone Sr. Plumbing Inspector 21835 (786) 714-2561 Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other compensation you received for each source of outside employment. If no income or compensation was received from a particular outside employment, enter zero (0) for that organization in the section below. If continued on a separate sheet, check here. ❑ Name and Address of the Source of Outside Income Nature of the Work Performed Total Amount of Money or Compensation Received All 4 One Plumbing, Inc 10795 NW 53rd Street Unit 201 - -- - Sunrise, FL 33351-- - - — - - Plumbingqualifier/ Consualtant - $1100 month) y I hereby swear (or affirm) that the information above is a true and correct statement. LluiA. Seen. Signature of Person Disclosing 5/30/2017 Date signed RECEIVED BY ELECTIONS DEPARTMENT., ❑ Hardcopy Electronic Copy OFFICE USE ONLY Accepted; Y / N Deficiency, Processed Date/Initlals; Scanned Date/Initlals; 13801-22 COE 2016