Lorenzo, Han 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 for .~ ,~ r-
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending: (/0(/1.)
THE MIAMI-DADE CouNTY CODE.
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Middle
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Filing as a (check one):
D Miami-Dad~ County Employee .
[tJ'MuniciPal Employee of: (7/:7 a/ ~~/. bACt!
or-~/c-P,/e:
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If your home address is exempt from public reco~!!J$u8nt
to Florida Statutes S 119.07, please check here: ~
Mailing Address (Street Name and Number)
CU' :4J'h / A.J
City
~~/' /!J-PA('/;
State
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Zip Code
3/37
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
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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