Jarahpour, Mohsen
"~ADEt
~~2~lY~~
JUN 0 3 2005
OUTSIDE EMPLOYMENT STA~
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: :2.,O{')"{
THE MIAMI-DADE COUNTY CODE.
Name: Last
--::r~e.A~. ~D-J (L.
First
~Ot-\ .S::e:--'V'
Middle
Filing as a (check one):
D JPlami-Dade County Employee
o Municipal Employee of: M \A.Yl \ ~
Position Title:
C ~'\ Nbv'N~""G-
County unicipal Department:
-e,V,L\)~ NG-
If your home address is exempt from public reco'!!!.P~uant
to Florida Statutes 9 119.07, please check here: Lj
Mailing Address (Street Name and Number)
-:vrSPji:1OL
CountylMunicipal Division:
Work Telephone:
303---673-f}{}od
f 67
Apt. #
~I Sw 0
6" CT
State
Zip Code
:53 I~.
k.-.
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
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Date Signed
tJ 6-03-aS'
1012e1ll0