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Joseph Keit 2016MIAMI•DADE OUTSIDE EMPLOYMENT STATEMENT MM 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 Nam1e' First Name ( Middle Name/initial 2016 Mailing Address — Street Number, Street Name, or P.O. Box 15x13 (A61 -e_ r�AIi A74 ., C",'(AS - 930 If your home address IF is exe 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) E] County ❑ Public Health Trust 2.96-nicipal / Y?L IM i lV� 61" �"l� �e . (Municipality) Department A n � � Division _ Position or Title Employee ID Number Work telephone r7w�,,c,Lkr I�E� 19?Ja 3©5=(_�7? 7/1 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 ®�l� /�+�� (1 33Y35_ tai {,o c- :4 I hereby swear r(ol�ffirm) that the information above is a true and correct statement. Signature of Trson 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