Andrew Chung 2018MIAMPDADE OUTSIDE EMPLOYMENT STATEMENT
031 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 Middle Name/initial
2018 ,
Mailing Address - Street Number, Street Name, or P.O. Box
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City, State, Zip
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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 C ►, j D j M I AWS
(Municipality)
Department
Division
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Position or Title��,,lI
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Employee ID Number
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elephone
75-67_1-7SSS
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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
of the Source of Outside Income
Nature of the
Work Performed
Total Amount of Money or
Compensation Received
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hereby swear (or affirm) that the information above is a true and correct statement.
Dat signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
RECEIVED
JUN 26 2019
CITY OF MIAMI BEACH
rOFFICE OF THE CITY CLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_01-22 COE 2016