Gonzalez, Elizabeth A 2004
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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 fo~ r) /,{) / I
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Endmgc:7"-(/ L
THE MIAMI-DADE COUNTY CODE.
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First
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Middle
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Filing as a (check one):
D fiami-Dade County Emplo~ee
CSl Municipal Employee oetty cf;. m \Q VY)~ W:h
Position Title:
If your home address is exempt from pUblic records p
to Florida Statutes 9 119.07, please check here:
Mailing Address (Street Name and Number)
8~Zo70 7a:tfu
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 continll9d 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.
Signature of
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