Jason Bugay 2018MIAMI -DAME OUTSIDE EMPLOYMENT STATEMENT
EM 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 list of each year, in accordance with Section 2-11.1(k)(2) of the Miami -Dade County Code.
Disclosure for Tax Year Ending ILastName First Name Middle Name/Initial
—2et87— Z�5 ) t 1 Bugay Jason L
Mailing Address — Street Number, Street Name, or P.O. Box
421 southeast 4th street
City, State, Zip
Deerfield Beach, Fl. 33441
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 El Public Health Trust Municipal City of Miami Beach
(Municipality)
Department
Division
Fire Department
Rescue
Position or Title
Employee ID Number
Work telephone
Paramedic
19728
(305) 673-7118
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
American Woodworks Flag Co.
421 Se 4th street
Deerfield Beach FL. 33441
Wood
Sales Based
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of
signed
Disclosing
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
13801-22 COE 2016