Iriando Reigio 2021COE 2014
11 Mz
OUTSIDE EMPLOYMENT STATEMENT
MIAMIDADE
For Full-time County and Municipal Employees
Full-time County and municipal employees -engaging _in outside
employment must file an annual disclosure report by July 1st of
Disclosure for
each year, in accordance with Section 2-11.1(k)(2) of the Miami-
Tax Year Ending:'
Dade County Code.
Last Name:
ova coo
First Name:
Middle Name:
Employee ID :
Filing as (check one) R Miami -Dade Co. Employee
❑ Municipal Employee of:
Position Title:
W�:)—A
County/Municipal Department:
County/Municipal Division:
If your home addres i exempt from public records
Work Telephone:
pursuant to Florida Statutes § 119.07, please see the
note on the following and check here: ❑
page
Mailing Address (Street Name and Number) Apt. #
City State Zip Code
Please list the sources of outside employment, the nature of the work, and the amounts of money or other
compensation you received. If continued on a separate sheet, please check here: ❑
Name and Address of the Source of
Nature of the Work
Amount of Money or
Outside Income
Performed
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing
Date Signed
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COE 2014
11 Mz