Martell, James A. 6/30/6
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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:
THE MIAMI-DADE COUNTY CODE.
Name:
First
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Middle
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Filing as a (check one):
D Miami-Dade County Employee
[gMunicipal Employee of: ~ . a )Vl. V B e(J..G h
Position Title:
I
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County/Municipal Department
CountylMunicipal Division:
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Work Telephone:
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Apt. #
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If your home address is exempt from public records pursuant
to Florida Statutes ~ 119.07, please check here: D
Mailing Address (Street Name and Number)
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City
State
Zip Code
3'3. S-1
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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
Outside Income
Nature of the Work
Performed
Amount of Money or
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
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Date Signed
t- -6'
Signature of Person Disclosing
10/261D0