Laura Cano 2021MIAMI•DADE OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municinal Fmnlovees
Full-time County (including Public Health Trust) and municipal employees engaging in outside employment must file an annual disclosure report
by July list 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 F 'rst NvA Middl Na a/Initial
2021
Mailing Address–Street Number, reetame�0. Box
City, tate, ip
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. ❑
Fililpg as an Employee (check one) /-\I _ ( . 0 I f- 4 1 n
4"County ❑ Public Health Trust ❑ Municipal
Nature of the
Work Performed J
Total Amount of Money or
Compensation Received
Q
An6 Owvc--010
(Municipality)
DepartmentDivisio
C�"'T
wl
Position or Title
Emp-2loyeeee `I1 Number
Work telephon6
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 thA Source of Outside Income
Nature of the
Work Performed J
Total Amount of Money or
Compensation Received
Q
An6 Owvc--010
I hereby swear (or affirm) that the information above is a true and correct statement.
OFFICE USE ONLY Accepted: Y / N
138 01-22 COE 2016
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
119ny aaoa
Processed Date/Initials: -" Scanned Date/Initials: