Juan Hernandez 2019M I A M I-DADE . • EEE7
OU T S ID E E M P L O YM EN T S TAT E M EN T
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 Name First Name Middle Name/Initial
2019 /le2o 4v d loar ¢
Mailing Address - Street Number, Street Name, or P.O. Box
T 3224 5) 75
City, State, Zip .
FL 33$ M-( o--
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)
O County □Public Health Trust [3 Municipal H-( o (ae
(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 beìow. If continued on a separate sheet, check here. O
Name and Address Nature of the Total Amount of Money or
of the Source of Outside Income Work Performed Compensation Received
Bloc pa0a d6& pot EC
óp42Uso t.15000 3224 5d o·P 33 ,
I hereby swear (or affirm) that the for ation above is a true and correct statement.
t
Signature of Person Disclosi
.2lg./rs
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