Pope, Theresa 05/31/06
."
;a; lit OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL .EMPLOYEES ENGAGING IN OUTSIDE
EMPlOYMENT MUST ALE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure for JrJo:5
1ST OF EACH YEAR IN ACCORDANCE VVITH SECTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): o Miami-Dade County Employee
B Municipal Employee of: <2.. \ T'y of '(h l r\;M l ~~c.., {-4
Position TiUe:
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CountylMunicipaJ Department CountylMunicipal Division:
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If your home address is exempt from public recon:JsOlSuant Work Telephone:
to Florida Statutes ~ 119.07, please check here: 6D$ (.,73 7'-17(;)
Mailing Address (Street Name and. Number) Apt. #
7~'60 Sw \()(, Ave
City State Zip Code.
Yl'\ l V2\ YY1 l ~L 33\13
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: 0
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Perfonned Compensation Received
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I hereby swear (or affinn) that the aforesaid infonnation is a true and correct statement
..S~ of Person ~n9 Date Signed
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