Judith Gonzalez-Pantigoso 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 I Last Name First Name Middle Name/Initial
2016 1 Gonzalez-Pantigoso Judith M
Mailing Address — Street Number, Street Name, or P.O. Box
461 NW 108 Terrace
City, State, Zip
Miami, FL 33168
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. ❑
Filling as an Employee (check one)
County 1771 Public Health Trust 0 Municipal City of Miami Beach
(Municipality)
Department
Division
Building
1510
Position or Title
Employee ID Number
Work telephone
Office Ass IV
17285
1(305) 673-7704
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
Primerica
5979 NW 151 Street #210
Miami Lakes, FL 33014
Life Insurance Sales
0
I hereby swear (or affirm) that the information above is a true and correct statement.
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
13801-22 COE 2016