Johnson, Henry
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RECEIVED
OUTSIDE EM~leJ:YMEMI4S'IA TEMENT
For Full-time Cp ~y( 'lqN4fli. if), ployees
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: Last
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F~y
Middle
Filing as a (check one):
D Miami-Dade County Employee
Municipal Employee of: ~I 'i 'liF M 1MV' 1 @..EAC.H_
Position Title:
~l()~ ?~NN~
County/Municipal Department:
CountylMunicipal Division:
If your home address is exempt from public records pursuant
to Florida Statutes 9 119.07, please check here: D
Mailing Address (Street Name and Number)
lb1' Nv0 'G.)'S .~(.~
City
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Apt. #
201-
State
rL-
Zip Code.
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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 Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
~~NIT"( }NT'L UN/'\J. k\-.JN'--1 f'~~$~ .1f 'C>C <~\OJh\
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Date Signed
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