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Diana Fontani 2016MIAMI•DADE OUTSIDE EMPLOYMENT STATEMENT p 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 1 st of each year, in accordance with Section 2-11.1(k)(2) of the Miami -Dade County Code. Disclosure for Tax Year Ending1700TP�0-1 t Name First Name '^ Middle Name/Initial 2016 fiAmIV — Mailing Address — Street Number, Street Name, or P.O. Box t 0 3 0tl) o A�tc k -t J`t.l� City, State, Zip I`1 r'kVA r IV-- (.- 3 3 t 3 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) ® County ❑ Public Health Trust Municipal ut T©e M r Aft r 13EA'C'H (Municipality) Department D� o Division ►���LZC SOE Posi ion or Title u LT C �N 0 S Employee ID Number ��S Wor telepho 3 r 73 — 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 f,VAVC r71go SW S71-"I-I\VE sus 'Ryj\LTO R cyva b0 0 I hereby swear (or affirm that the information above is a true and correct statement. Signature of Date signed RECEIVED BY ELECTIONS DEPARTMENT: ❑ Hardcopy ❑ Electronic Copy OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials: 13801-22 COE2016 ry 071