Martinez, Juan Carlos
" ,",rnT
....
"~ADEt OUTSIDE EMPLOYMENT ST A TEJlJri~1) LUU'i
For Full-time County and Municipal Employees
a:sy - _H_._
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE Time
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 First Middle
N Ct gt l ne.L- ---- ca12LoS
~uan
Filing as a (check one): D Miami-Dade County Employee Be.ctc.'"
00 Municipal Employee of: ~ lClH \
Position Title: LiFEGUaQO T.
County/Municipal Department: CountylMunicipal Division:
H iAAi f}p'~r~l Fil2E f)~PItRTN,evr N,bh Oce4V1 {{e6CUe
If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes 9 119.07, please check here: D 305-673-771,/
Mailing Address (Street Name and Number) Apt. #
6 cr30 f" Lu . '"7qTH s'T. t 07
City tJ i aN ( State rL Zip Code.
3301.5'
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 ofthe Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
HitlNr DADE Ai~ Gl1 \ancE. E' ~.:-~ (~('-{ E Q-
I
Z I 66 IV W . 62 rti :;"r ~V)(1 He DiCqL b IO.O() pcr hco ("s
N/Cl1'1i F L i 3.3' if 1 -r2ch n Ie i4 tV )
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing C[>1(~ Date Signed
00;/ ~ i /05.-
I
RECEIVED
101261D0