Behrens, Chris
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OUT51'DE EMPLOYMENT 5T A TEMENT
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.
I
Name: Last \ First Middle
f<LkM'V-1 \ CAd If
Filing as a (check one):
o Miami-Dade County Employee
0' Municipal Employee of: C~ 7>" if,r... /11 J. t9 --l. l"3A.Atf%.l'
Position Title:
. ~ ~If u 'l"4.rr"~ 7'
countylMu~a~ Department '
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If your home address is exempt from public reco'!!:!PJPSuant
to Florida Statutes 9 119.07, please check here: M'
Mailing Address (Street Name and. Number)
CountylMunicipal Division:
Work Telephone:
Apt. #
City
State
Zip Code,
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 Nature of the Work
Oul$idelncome Perfonned
at'{ 'A(,;~~ a-t~ ~"""r.rrl"tele-t"~.,~
.J'tJ 7 h A-c;c.A1( . /J tI.. ,
~"-l S,#~r;
Amount of Money or
Compensation Received
cP$//er 'f.
t
7;
I hereby swear (or affirm) that the aforesaid infOtmal1on Is"a trUe and correct statement.
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Signature .~ .,.,.,.. nO" . 19 /"'7 ~. ::;t. I .....bi' '...l:.. U i il iI.. ..i v
-'7 ""T~7/C-~ .
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Date ~ig,d /. .
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11l/2M1O