Meshach Fruster 2021MD%MI•DADE 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 Last Name
jj First Name Middle Name/Initial
2021 Y().S fiC� S
Mailing Address — Street Number, Street Name, or P.O. Box
q
6 -f-h pl
City, State, Zip f
3
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. ❑
Filing as an Employee (check one)
❑ County ❑ Public Health Trust Municipal C(4y Q K"t 8eccA
(Municipality)
Department
Division
Position or Title
Employee ID Number
Work telephone
1�110g3305
x'73 7�
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 (0) for that organization in the section below. If continued on a separate sheet, check here. ❑
Name and Address
of the Source of Outside Income
Nature of the
Work Performed
Total Amount of Money or
Compensation Received
I hereby swear (or affirm) that the information above is a true and correct statement.
of Person Disclosing
ORL's 0-U9,9
Date signed
OFFICE USE ONLY Accepted: Y / N Deficiency:
13801-22 COE 2016
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
Processed Date/Initials: ,�=j 7Date/Initials:
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