Evan Prentiss 201811,411AM11,1116ME OUTSIDE EMPLOYMENT STATEMENT
'N-1,111 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 Prentiss Evan Scott
-Walling Address — Street Number, Street Name, or P.O. Box
12451 SW 89th Court
City, State, zip
Miami, FI 33176
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 Emplotree (chectl one)
County [3 Public Health Trust E3Municipal City of Miami Beach
(Municipality)
Department
Division
Fire Department
Fire Suppression
Position or Title
Employee ID Number
Work telephone
Fire Captain
18363 1(305)
673-7179
Please list the sources of outside employment (including self-employment), the nature of the work, and the IQ.W 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 =r (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
Miami Dade College
950 NW 20th Street
Miami FI, 33127
EMS instructor
Varies
I hereby §ygar (Wirm) that the information above is a true and correct statement.
Signa
ti642,;_;7S1
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
[:1 Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned DateAnitials:
138_01-22 COE2016