Matthew Atwell 2019M :..A i !i·l·DAD E-
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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()2) of the Miami-Dade County Code.
Disclosure for Tax Year Ending
7010
2019
Last Name
[hosp
First Name Middle Name/Initial
Mailing Address - Street Number, Street Name, or P.O. Box
T503I "
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. D
Filing as an Employee (check one)
[] County [] Public Health Trust K]Municipal A1o Ph !''' E-!
Department
kee D Divisio\½:toc.~
Position or Title
Di
Employee ID Number
[741 7
Work telephone
3o/63/700
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
of the Source of Outside Income
Nature of the
Work Performed
Total Amount of Money or
Compensation Received
I ereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
O Electronic Copy
OFFICE USE ONLY Accepted: Y I N Deficiency: Processed Date/Initials: Scanned Date/Initials: _
138_01-22 COE 2016