Camber, Diane 6/22/06
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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: '::>-00 5
THE MIAMI-DADE COUNTY CODE.
Name: last
First
Middle
\6..n
o Miami-Dad~ County Employee
5ZI Municipal Employee of:
Filing as a (check one):
Position Title:
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CountylMunicipal Division:
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If your home eddress is exempt from public recorrJs pursuant
to Florida Statutes!j 119.07, please check here: 0
Mailing Address (Street Name and Number)
<Sh.z-~" d Go-
Work Telephone:
305 ~ b13~1';"5C
Apt. #
S1ate
Zip Code
F
33
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
OulBide Income
Nature of the Work
Performed
Amount of Mon"y or
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Date Signed
~
10126100
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