Osmany Leon Barrello 2021It v
DocuSign Envelope ID: CD78029D-656C-4FE7-91 C8-841A76A64949
MIAMI.QADE OUTSIDE EMPLOYMENT STATEMENT
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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.
t)issipsiire fflr Tax Year EridingLasttamo FlrsjN a Middio Name/inihal
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Milling Address Street Number, Street Name, or P.O. Box
>511,-
City,SZip �_-...
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. LJ
Fflima as an Emninvee (ehaek anel n — r r
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❑ County ❑ Public Health Trust Municipal t at Sri
(Municipality)
Department,
Division
.....
Positiono_r Tib -tie
Employee ID -,Number Work telephone
Please list the sources of outside employment (including self-employment), the nature of the work, and the Loki 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 Z,rq (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
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I hereby svi� Tira10 m) that the Information above is a true find correct Statement. RECEIVED BY ELECTIONS DEPARTMENT:
CHardcopy
f, .. _.........._. _ ._ / [ Electronic Copy.
C;/5(gnat6re of Person Disclosing
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Date signed
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OFFICE USE ONLY Accepted: Y / N _._,.._....._. -__,. _T .... _ scanned Catoiiti.ii3:7