Martell, James A.
"~ADEt
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
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
206CC;-
First
--:rR-m ~. s
Middle
Name: Last
Filing as a (check one):
D Miami-Dade County Employee
G:]MuniCipal Employee of: CI'n.; d F /J1 f Afrl;' tSl54<H
Position Title: /J
1"-1 /A/',l-/[
County/Municipal Departm~nt:
C/ ~UCII
If your home address is exempt from public records pursuant
to Florida Statutes 9119.07, please check here: D
Mailing Address (Street Name and Number)
~O () :5;"<.; / e:, c. 72,(j(
CountylMunicipal Division:
Apt. #
City
/I7/4mt
State
Zip Code.
331J7
/E-
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
/<0 '71-{ S 779-I'l ~AJ.$ T
I ,
1/4-/ N T7 NY
VI1-t!If:-5
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing
/n'~
Date Signed
C - z.y-oS-
101261D0