Jason Bogk 2019.» ETI 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 2-11.1k)2) of the Miami-Dade County Code.
Disclosure for Tax Year Ending /Last Name
2019
Fir st Name »«. Middle Namo/initial
4
Mailing Address - Street Number, Street.
0S{0 50 ()
me, or P9. Bo
, 4
City, State, Zip
3
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 (cbeck oe)
l- { [] County [] Public Health Trust E Municipal nu4"hi !to
(Municipality)
Department
e
Division
re
Position or Title Employee ID Number
1
Work telephone
3es- €73-7/10
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. [
Name and Address Nature of the Total Amount of Money or
of the Source of Outside Income Work Performed Compensation Received
kewkall e« Ils" n ·
[I75 6' 4} $1t, [w, 3313 Taca a3 t /ye.,
fla D«k lye medic! Grps ka±ti Ct»kl rhr 1,ewe/, 5¢ lo 20 5+e¢} WowiF, 34127
I
I hereby swear (or affirm) that the information above is a true and correct statement.
son "Credo.i o.no
Date signed
7-7-320
RECEIVED BY ELECTIONS DEPARTMENT:
_j Hardcopy
[] Electronic Copy
REMEMBER TO PRINT, SIGN, AND SUBMIT TO ELECTIONS VIA EMAIL OR HARDCOPY.