Orlando Pez 2019M IA M l·DAD E -
ETTI
O U T S ID E E M P L O Y M E N T STAT E M E N 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 Z 0LA)D 2 GA
Mailing Address - Street Number, Street Name, or P.O. Box
2336 So 33 $T
City, State, Zip
33029 Pue P1«)es I R
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 [X ííunicipal IT9 - W1/A41 8]
(Municipality)
Department Division
fee DCA 2Su
Position or Title Employee ID Number Work telephone
1 LG2AD - 2o 4 u2 y 1 7 14 L-
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
CItq 0 HA)De 8CA cG0APA
4 o S FD EA Ha
H%LL_A)D2 d c
iCL 33007
I hereby swear (or affirm) that the information above is a true and correct statement.
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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