Harold Viera 2019MtAMHlADE. EEIi · 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 repo
by July 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami-Dade County Code.
Disclosure for lax Year Ending \Last Name
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First Name
Mailing Address - Street Number, Street Name, or P.0. Box
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Middle Name/initial
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city, State, Zip R.O
313
lf your home address is exempt from public records pursuant to Florida Statutes 5$119.07, please see note on the following page and check here.L_]
Filing as an Employee (check one)
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[K county [] Public Health Trust O Municipal
(Municipality)
Department Division
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Position or Title Employee ID Number l Work telephone
[IF+Hr€ 20742 30 673 )13o
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. Ht continued on a separate sheet, check here. []
Name and Address Nature ot the Total Amount of Money or of the Source of Outside Income Work Performed Compensation Received
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I hereby swear (or affirm) that the information above is a true and correct statement.
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Signature of Person Disclosing
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Date signed
RECEIVED BY ELECTIONS DEPARTMENT;
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