Joseph Keit 2018Si nature oiN\4 et Disclosing
Date sign d
MIAMIDO OUTSIDE EMPLOYMENT STATEMENT
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.
Middle Name/Initial
2018
Mailing Address — Street Number Street Name, or P.O. Box
City, State, Zip
ql S ifil 00 ''71 /\)e LJ 41
C.Or c-, ( (1111CP 3 /Or 14 6\. ,561 I
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rom public records pursuant to Florida Statutes §119.07, please see note on the following page and check here. q
Filing as an Employee (check one)
Health Trust Municipal j (C /1/1 C AA n County n Public
(Muni polity)
Department
riT CA
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Division
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Position or Title
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Employee ID Number
1 6 .1
36
Work telephone
305-- (-) "7 3 -7(35
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 t[w 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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Disclosure for Tax Year Ending Last Name
S .
" First Name
C91
If your home address is exe
I hereby swear (or affirm) that the information above is a true and correct statement. RECEIVED BY ELECTIONS DEPARTMENT:
q Hardcopy
q Electronic Copy
Scanned Date/Initials: Processed Date/Initials: OFFICE USE ONLY Accepted: Y / N Deficiency:
138_01-22 COE 2016