Nickholas Butler 2019MIAM~- ERI
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 I Last Name First Name Middle Name/Initial
2019 Butler Nickholas V
Mailing Address - Street Number, Street Name, or P.O. Box
3751 NW 27th St
City, State, Zip
Lauderdale Lakes, FI,33311
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. O
Filing as an Employee (check one)
D County D Public Health Trust 'iwunicial City of Miami Beach
(Municipality)
Department Division
Public Works/Sewer Sewer
Position or Title Employee ID Number I Work telephone
Sewer Field Operations Supervisor 23616 (305) 673-7620
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. O
Name and Address Nature of the Total Amount ol Money or
of the Source of Outside Income Work Performed Compensation Received
Broward County Football Officials High School Football Official $77per game
Association
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
7/5/2¢
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
O Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/initials.
138 01-22 COE 2016