Andrew Swasey 2018MIAMMACE
OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
Full-time County and municipal employees engaging in outside
employment must file an annual disclosure report by July 1 st of
Disclosure for
each year, in accordance with Section 2-11.1(k)(2) of the Miami-
Tax Year Ending:
Dade County Code.
Last Name:
SU45
First Name: Middle Name:
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Employee ID #:
Filing as (check one) ❑ Miami-Dade Co. Employee
F;rMunicipal Employee of:
Position Title:
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Count rMu� cipal Department:
County/Municipal Division:
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If your home address is exempt from public records
Work Telephone:
pursuant to Florida Statutes § 119.07, please see the
note or, the following and check here: ❑
page
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1
Mailing Address (Street Name and Number) Apt. #
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City State Zip Code
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Please list the sources of outside employment, the nature of the work, and the amounts of money or other
compensation you received. If continued on a separate sheet, please check here: ❑
Name and Address of the Source of
Nature of the Work
Amount of Money or
Outside Income
Performed
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing
Date Signed
J
COE 2014