Jovanni Roman 2019M IA M l·DAD E - EI
O U T S ID E E M P L O Y M E N T STAT E M EN T
For Full-tim e C ounty and M unicip al Em ployees
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 o m-Ar) - 2019 -JVA 00 I
Mailing Address - Street Number, Street Name, or P.O. Box
+30 GD) I5LS D1ve A P T 1o1 .
City, State, Zip
HA LA' DAL e £ I 330%
I
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 LYí unicipal CIT4 o M IA4 BE CHA
(Municipality)
Department Division
e ce A) Res ou
Position or Title Employee ID Number Work telephone
P7 LI G0ND r 147 / y1 714
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
Pr 6 A O) 0r 4
405 ) (5 4 Pi-FT
0P 6 3 391, F
I
I hereby swear (or affirm) that the information above is a true and correct statement.
Signature of Person Disclosing
Date signed
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