Burt, Jose 6/19/06
RECEIVED
CITY OF ~1IAMI BU,CH
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200S JUN 2 I All 7:
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
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending:
lliE MIAMI-DADE COUNTY CODE.
Name: Last
/J IL+
First r. /
-.J CJSe,
Middle
Filing as a (check one):
o Mlami-Dade County Employee
~ Municipal Employee of:
;?;m. / f7
Cl
en
c
Position Tille:
u l' ~I<$ ~~V
If your home address is exempt from public recorrI8..----fUf3uant
to Florida statutes g 1.19.07. please check here: U
Mailing Address (Street Name and. Numbe"
II?. 7 I M /tJ3!:.dI 4r/e.
City
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(
al1/e.
CountylMunicipal Division:
, e<</ey- ~J?7
Work Tele hone:
(30S- ~ 73 ~ ?~.2 -
Apt. #
G4Y~n5
State
r:L
Zip Code,
.3 ;3tf//8
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 8 separate sheet, please check here: 0
Neme and Address of the Source of
Ouf$lcIelncorne
(!./JYlt!tJ €Jee/r; 'e J-.ltJ y
;30/S- e lot!>&v(f
}t/.--m/Uh. PL '398/3
'be 5" (p 1/- (J7/tJtJ
NBture of the Work
P8Jfonned
,<.; c7 7'b y "i/n? "p
Hee:lzCjn/~
Amount of Money or
Compensation ReceIved
1/;z,(JcJ-!kvv.
I hereby swear (or affirm) that the aforesaid Information is a true and correct statement.
, Signature of P
D6~ni9-0b'
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