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Chief Daniel Oates 2016+ s�• �'.. �JiY��7�� S�A��i�� For Full-time County and Municipai Employees Ful!-time Ccunty (inciuding Public Health Trust) antl municipal emplayees engaging in outsitle empioyment must file an annual disclosure report by July 1st oi each year, in accordance with Section 2-11.1(k)(2) af the Miami-Dade County Cotle. Disciosure fipr Tax Year Ending Last Name First Name �`�l ` za, s l- �� , �� y�l� � � (,_,F � ..� Nlaiaing Address — S#reet Number, Street Name, or P.O. Box �,�C J C,3 G�° � J�� N��` ;� v 2., City, State, Zip � � .�,Y� � t`:�'� � �� ' L � � i :� `f �Aiddle Name/Initia! , 1 If your horne adtlress is exempt frorr� public records pursuant to Fiorida Statutes §119.07, piease see note on the following page and check here� ��t��g as a6t IE�tlplOyee �checic one} �] Cownt� �] �ublic �iealth Trus4 �Municipai Departmeni � G` � t L, ,c,... ��.� :` jr° i,�'�'1 l�. ,�` U Position or Title �..�� t— C✓� � �a �.. i �-,� , � �� 3,'_l� c� M � {Municipality) Division Employee ID �iumber �-� `t' � ,�j� Woric telephone .� �� `�7 ✓ -��1� Please list the sources �f uutside employment (inci�ding seif-employment), the nature of the work, and the tata4 amounts of money or other compensatior you received for each source of outside employment. If no income or com�ensation was received fram a aarticular outsitle employment, enter z2rc (0) for that arganizatior i� �he sectian eEio�J. If c�;rst��aa�ed oro a separaie shseY, chec;c hsr�. � �Name and Address � � of the Source af Outside lnccme r �(.Za`dLi�}�} ( Pee��'�r"'�G' �r^,.i?�. t.'1i.1 ��1 � c i � ��... -°�;.� �:;��;�,��'`��:j-�'� �, , c';� t'� ��''•'� a3`�t��-�-t- �c.�� :,�� -� i � � t �,�� L� �� , �,� �r, i � -�.;�� #�� ' t_.._ .� � i 3� 1 hereby swear (or affi ,6Jyhsrsan Discicsing ��Ij� Date signed Na#ur2 of the Work Psrforrried �� .�u r �� .5 S �:r� 7atal Amount af Money or Compensa#ion Received ��'>f�C: f};u.'uJ'�- �" �� I information above is a true and correct statement. Recfeveu sv eiECztoNs o�PaRT�nn�H7: � Flardcopy /.�!�` � � Eiectronic Copy OFFiCE USE ONLY Accer�te�:: Y;` +i Deiic�enc�,: Processed Date;initiais:_,______._______. Scannec Date/Imtiais: -i3E 0��-22 CCE201G � 7'�ID� � PL�I( E T N��R �+►�'ICiI� Required by the lVliami-Dade County Code; Seciion 2-11.1(k)(2) t)UTS'DE E�VI9��i3Y�lt�t�T means providing personal s�rvices, other than to Miami-Dade County, or to the respective municipality, that are compensated or traditionally compensated, including but not iimited to, being an employee, an independent contractor, an agent, or by self-employment. Please note that this form is to be used only to report Outside Emp�oyment; it is separate from the Source of Income Statement. If you are required to file a Source of incame Statement and you also engage in outside employment, you must complete both ihe Outside Empioyment Staternent and the Source of income Statement. FI�Ih1CG If�STRIJtGT'lONS This 'torm must be filed by July 1st of each year, The form shauld only be filed by em�(oyees who have outside empioyment to disclose. �lliami-�ade �ounty fc�il-time personnei {includir�g Public �iea3t� Trust personne8) shail file completed r"orms with: �ia�ai-�Dade Elections Qepar#mer�� ,�i#n: Financial �isciosur� Secti�� 270� NV�f 87#E� Avenaae iViiaan►, F� 33172 or i? O. Box 52� 550 �orai, �i. 33952-155i9 through emaii: financiai.disciosures@miamidade.aov Nlunicipal fuil-time personn�l shal! file completed forms with their rsspective AAur�icipal C1erk. For fiurther infiormation, Miami-Dade County and Public Health Trust employees rnay contact the Miami-Dade Elections Department Financial Disclosure Section via telephone at 30�-4J9-8415 or via email at financial.disclosures@miamidade.pov. Municipal empfoyees may contact their respective vlunicipal Clerk's �ffice. Note �tE: Fforida Statutes § 119.�7: The roie of our office is to receive and maintain forms filed as public records. ii yeur homs address is exempt from disclosure and you do not wish your hom2 address to be made public, please use your office or other address for your mailing address. The following persons are exempt from disciosing their home addresses: active or former law enforcemeni personnel, including correctional and correctional probation officers, personnel of the Department of Children and Famiiy Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other criminal activities, personnel of the Department of Nealth whose �uties ar2 to support the investigation of child abuse or neglect, and personnel of the Department af Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement; firefighters; justices anC jtadges; current or former state attorneys, assistant state attorn2ys, statewide prosecutors, or assistant statewide prosecutors; county and municipal code inspectors and code enforcement officers. COE 207�