Lester Caballero 2016MIAMI•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
2016���+'G'
Mailing Address — Street Number, Street Name, or P.O. Box
City, State, Zip
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. ❑
Chinn ac an FmnlnvP-P_ /rhnrk nnP1
rl County Public Health Trust Municipal
(Municipality)
Department
X/ O. d 02471, les c low-
Division
l� � de44r JB
Position or Title
Employee ID Number
Wift telephone
14? 5 49
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 So rce of Outside Income
Nature of the
Work Performe.0
Total Amount of Money or
Compensation Received
�QS�r
tc Vt
-71 hereby swear (or affirm) that the inforfn ion ab ov isa true and correct statement.
Signature pperson Disclosing
6
_00 r. 12 ,& -?
Date s) ned
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
13801-22 COE2016