James Zeigler 2019MIAMI-DADE . EII
OUTSIDE EMPLOYMENT STATEM ENT
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()(2) of the Miami-Dade County Code.
Disclosure for Tax Year Ending Last Name
ors Z
Middle Name/Initial
2
Mailing Address - Street Number, Street Name, r .O. Box
(7oo aw«vu-ha »le D
City, State, Zip
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 D Public Health Trust
(Municipality)
Department ab, 7.-.. e ""p..
Employee ID Number
I54;5
Work telephone 7.
es-Ct-100·21£
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 (O) 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
I hereby swear (or affirm) that the information above is a true and correct statement.
r
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
[] Hardcopy
[] Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials:
138_01-22 COE 2016