Yohank Benitez 2016rf's.f•��- OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
Full—time k (including Public Health Trust) and municipal employees engaging in outside employment must file an annual disclosure report
by July lstch year, in accordance with Section 2-11.1(k)(2) of the Miami -Dade County Code.
p iscfosU'1"ix Year Ending ILastName First Name
Middle Na
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Street Number, Street Name, or P.O. Box
Mailing Add-
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city, Statet
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if your hoMe�ess is exempt from public records pursuant to Florida Statutes §119.07, please see note on the following page and check here. ❑
Filing as Anployee (check one)
County n Public Health Trust n Municipal
(Municipality)
Department Division -
Position or Titi Employee ID Number Work telephone
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Please list the kirces of outside employment (including self-employment), the nature of the work, and the total amounts of money or other
compensation Yj received for each source of outside employment. If no income or compensation was received from a particular outside
employment, erk- zero (0) for that organization in the section below. If continued on a separate sheet, check here. ❑
0
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Name and Address
he Source of Outside Income
Nature of the
Work Performed
Total Amount of Money or
Compensation Received
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�..:l hereby swear (or Wfirm)-tha e f rmation above is -a true and correct statement.
Signature of per%d Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
13801-22 COE 2016 .