Tiffany Dallas 2018 MIAMIan OUTSIDE EMPLOYMENT STATEMENT
COUNTY For Full-time County and Municipal Employees
Full-time County(including Public Health Trust)and municipal employees engaging in out§ide,em tlyment must file an annual disclosure report
by July 1st of each year,in accordance with Section 2-11.1(k)(2)of the Miami-DaCIt~,Co(int (3edt
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Disclosure for Tax Year Ending Last Name First Na a MiddlepName/Initiall
2018 Dale-�;�` I� ; C`!MIC_
Mailing Address—Street Number,Street Name,or P.O.Box '
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City,State,Zip
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 0"Municipal M (3 eAC1-1
(Municipality)
Department Division
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Position or Title Employee ID Number Work telephone
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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 Nature of the Total Amount of Money or
of the Source of Outside Income Work Performed . Compensation Received
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I hereby swear(or affirm)that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT: _T
❑Hardcopy
4 ❑ Electronic Copy
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Sign ur of Per'so 'sclosingct
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Date signed f 7 ;`7! V l 11i E: .Z
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OFFICE USE ONLY Accepted: Y/ N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_01-22 COE 2016