Giancarlo Pena 2016MfAMI.DADE OUTSIDE EMPLOYMENT STATEMENT
Em 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 j Middle Name/Initial
2016 Y o 1`�,onk0J
Mailing Address—Street Number, Street Name, or P.O. Box
t
City, State, Zip
I `` l , k o& X31
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 CA -W QV int IW 1 Ae_
(Municipality)
Department
P"JU
Division
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Position or Title
Employee IDN mber
ork telephone
VI IC
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
Cn�►St ;h�v>314 �, vL,, L
r-1,4
hereby swear (ofqffirm) that the information above is a true and correct statement.
Signature of Pers, Disclosin-"
m I t2 1 �`+
Date signed
RECEIVED BY ELECTIONS DEPARTMENT.
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_01-22 COE 2016