Lazaro Rodriguez 2016M[AMI-DMADE OUTSIDE EMPLOYMENT STATEMENT
=71 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 N eFirst Name Middle Name/Initial
2016 �4 � U�+2 �92•ss�
Mailing Address — Street Number, Street Name, or P.. Box
/-7OCO
City, State, Zip
Aooxl�A.411
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)
0 County ❑ Public Health Trust ❑ Municipal / VAII * QA. -.49 �!
(Municipality)
Department
Divisi
sfum
Position or Title
%1--c ' f'a �u s �E� �a r-
Employee ID Number
2 v S'!a 3
Work telephone
305-613 l0 77
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
t -c.-- W-7
�Or
0-"X
SAIWII
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 COE 2016