Shawn Kouri 2019MIAMI-DADE. GTE
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 Las(
4
Name First Name Middle Name/Initial
2019 oon1 sleo«! M/\
Mailing Address - Street Number, Street Name, or P.O. Box
lIs N 8 8 sr
City, State, Zip
MA P A] e 33138
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)
DJ county [J Poe Heat must 7 wom car City o M-PM (enc
'] (Municipality)
Department
Position or Title
/y 'ucd
Division
Work telephone 2-
6 73- 774
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. D
Name and Address Nature of the Total Amount of Money or
of the Source of Outside Income Work Performed Compensation Received
Pro cT Ro- liw«&0)s 6 W4 bCS&Ju)> R2el}- % 3 8 ) Ak e o s AU€ d»3 2Te
on-(o) L F, 33304 -
irm) that the information above is a true and correct statement.
1
7/oho
Date signed ( 1
RECEIVED BY ELECTIONS DEPARTMENT:
O Hardcopy
O Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/initials: Scanned Date/lnitials:
138_01-22 COE 2016
Received 27 August 2020
Office of the City Clerk