Michel Tessier 12.3124Clear From Print Form
MIAMI-
� SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st of every year. , 1 Disclosure for Tax Year Ending
2022 Maili�g �ddr� -Street Number, Street Name, or P.O. Box\ b , , c; �, ., -�,e>W/>City, State, Zip \J\.
('\ Middle Name/Initial
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If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. D
Filing as an Employee (check oH)
D County □ Public Health Trust □Municipal:
(Municipality) Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
D County �Municipal:
(Municipality) Board where serving v;cc --Alternate address (if home address is exempt) Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.□Name of Source of Income Address
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ion above is a true and correct statement.
Signature of Person Disclosing
\� \�. �L/� Date signed
Description of the Principal Business Activity
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RECEIVED BY ELECTIONS DEPARTMENT: □Hardcopy�lectronic Copy
REMEMBER TO PRINT, SIGN, AND SUBMIT TO THE OFFICE OF THE CITY CLERK VIA EMAIL OR HARDCOPY,