Osteydi Cobas 2015"—FMIII•DADE OUTSIDE EMPLOYMENT STATEMENT
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
/'.
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2015 �� el 1, I t
Mailing Address — Street Number, Street Name, or P.O. Box '\ ,D
City, State, Zip
L I �t Z
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)
El County Public Health Trust unicipal + '�- y (�; M,' c. Yy\ I e 4
(Municipality)
De artment
Division
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07000 —
Position or Title
Employee ID Number
Work telephone
96 -; 4 :?c cxN
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
ZU5� rkrn�=1"r <<rv` i vC"\,
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-t-
07000 —
tA,�,r-"\ek�r) TL 330�_5
I hereby swear (or affirm) that the information above is a true and correct statement.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy_
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
13801-22 COE2016