Fliss, Eric B.
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OUTSIDE EMPLOYMENT STATEMENT
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 Disclosure for
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K}(2} OF Tax Year Ending: 2.005
THE MIAMI-DADE COUNTY CODE.
Name: Last
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First
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Middle
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Filing as a (check one): 0 Miami-Dede County Employee
181 Municipal Employee of:
positionTltle~ '( (\"'L C"",lbu.'-AL +~c..~\\t~~ MO('\A~et'L-
CountyJMunicipal Department:
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If your home addmss is exempt from public recOtrJs,.....pufSuant
to Florida Statutes ~ 119.07, please check here: U
Mailing Address (Street Name and. Number)
CountyJMunicipal Division:
Work Telephone:
Apt. #
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Zip Code.
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State
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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: D
Name and Address of the Source of
Oul$1de Income
Ano'hQ./" ~A~ M'Q~~Men'"
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Nature of the Work Amount of Money or
Performed Compensation Received
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I hereby swear (or affinn) that the aforesaid Infonnation is a true and correct statement
" Signature of Person Disclosing
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