Joel Mizelle 2019MIAMIDADE
COUNTY
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.
Disclosure for Tax Year Ending Last Name First Name Middle Name/lnitial
2019
Mailing Address — Street Number, Street Name, or P.O. Box
City, State, Zip
If your home address is exempt from public records pursuant to Florida Statutes 5119.07, please see note on the following page and check here.
Filing as an Employee (check one)
County Public Health Trust 7MunicipaI dfzaOÅ
(Municipality)
Department Division
Position or Title Employee ID Number Work telephone
3ö5¯ 6-73 7 //O
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 be\ow. if contioued on a separate sheet, check here.
Name and Address
of the Source of Outside Income
/ 95%' p04,a
,-44
) 3
Nature of the Total Amount of Money or
Work Performed Compensation Received
/zvS
I hereby swear (or affirm) that the information above is a true and correct statement.RECEIVED BY ELECTIONS DEPARTMENT:
e.-—Sig ature of Person Disclosing
Date gned
OFFICE USE ONLY Accepted:Y / N Deficiency:
138_01-22 COE 2016
Hardcopy
Electronic Copy
Processed Date/lnitials:Scanned Date/lnitials: