Fernando Palomo 2019» ETE7
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~e First Name Middle Name/Initial
2019 a (o o 7e a0l o - .
Mailing Address - Street Number, Street Name, or P.O. Box
4et. 7O o o U'U o st a18&
City, State, Zip 2/a e L >>05
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.Dl
Filing as an Employee (check one)
[] county D Public Health Trust O Municipal
(Municipality)
Department Division
Position or Title Employee ID Number Work telephone
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. []
Name and Address Nature of the Total Amount of Money or
of the Source of Outside Income Work Performed Compensation Received
s a tele( Gelers f- tue«( •45/
above is a true and correct statement.
Signature of Person Disclosing
2/24leo
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
Received 27 August 2020
Office of the City Clerk