Evan Prentiss 2016Disclosure for Tax Year Ending Last Name First Name Middle Name/Initial
2016 Prentiss Evan Scott
Mailing Address — Street Number Street Name, or P.O. Box
12451 sw 89 court
City, State, Zip
Miami, Fl 33176
a
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.
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. 1=1
Filing as an Employee (check one)
County n Public Health Trust Municipal City of Miami Beach
(Municipality)
Department
Fire Department
Division
Fire Rescue
Position or Title
Lieutenant
Employee ID Number
18363
Work telephone
(305) 673-7136
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. q
Name and Address
of the Source of Outside Income
Nature of the
Work Performed
Total Amount of Money or
Compensation Received
Baptist hospital
8900 N Kendall Drive
Instructor of American Heart
Association classes
$8000
Miami Dade College
950 NW 20 St
Paramedic Instructor $12000
I hereby swear (or affir 7 ) Mat the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
q Hardcopy
q Electronic Copy
Signature of P on Disclosing
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials:
138_01-22 COE 2016
Scanned Date/Initials: