Jason Bogk Outside EmploymentMIAMI-DAM OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees COUNTY
First Name
J (66\
Middle Name/Initial
Mailing Address — Street Number Stree me, or .0. Box 47(
Disclosure for Tax Year Ending Last Name
20K. 141 gOtak
re— 331“0
City, State, Zip
et next
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.
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.0
Filing as an Employee (check one)
q County q Public Health Trust FMunicipal #11 0$11 a e 4
(Municipality)
Department
F re
Division
Position or Title
rt‘ re's ill *PP
Employee ID Number
1 q t /
Work telephone
Lit ii- sa7-Lio 7g
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. q
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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lino ,v W C f I. , sfreet .
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I w o £'J VI s-keel, ill`on, ) CI- 331/r
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7 CIIIICal AffI
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I hereby swear (or affirm) that the information above is a true and correct statement.
RECEIVED BY ELECTIONS DEPARTMENT:
q Hardcopy
q Electronic Copy
Sig y ure of Person cl sing
Date signed
Processed Date/Initials: Scanned Date/Initials: OFFICE USE ONLY Accepted: Y / N Deficiency:
138_01-22 COE 2016