Maxillo Fanjul 2019MIAMI-DADE. . EE
OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
+4
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
os FA N J L
First Name Middle Name/Initial
D. Je
Mailing Address - Street Number, Street Name, or P.O. Box
82/A c oon
City, State, ip
33 21
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)
D County D Public Health Trust [ Municipal Cd9 Lai) ecc
(Municipality)
Department Division
O ecv <esc a ra he/Coe?es?co
Position or Title Employee ID Number Work telephone
0 (es e « LA 4 a 9
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 Nature of the Total Amount of Money or
of the Source of Outside Income Work Performed Compensation Received
Cd4 o U ng ass T f
p' cu Ke6ce S oer9 G L 1ò 4x
Wllq 0 ovt u¢e Da#, Jo\arla=o
Pie '/Feo s
I hereby swear (or affirm) that the information above is a true and correct statement.
7/3]/aoLo
Date sirs "
RECEIVED BY ELECTIONS DEPARTMENT:
D Hardcopy
[] 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