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O'Hara, Michael P. OUTSIDE EMPLOYMENT AND DISCLOSURE OF BUSINESS INTERESTS FINALCIAL STATEMENT FULL-TIME HACOMB EMPLOYEES ENGAGING IN OUTSIDE EMPLOYMENT OR SERVE AS A DIRECTOR/OFFICER OF A FOR- PROFIT CORPORATION MUST FILE AN ANNUAL DIS/SHAREHOLDER CLOSURE REPORT BY JULY I ST OF EACH YEAR IN ACCORDANCE WITH THE SPIRIT OF SECTION 2- I I. I (K)(2) OF THE MIAMI-DADE COUNTY CODE Disclosure for Tax Year Ending: 2004 Name: Last O'Hara First Michael Middle P. Position Title: Director of Special Programs If your home address is exempt from public records pursuant to Florida Statutes S 119.07, please check here: 0 Mailing Address (Street Name and Number) 9233 North Miami Avenue City State Zip Code Miami Shores FL 33150 Please list the sources of outside employment, the nature of the work and the amounts of money or other compensation you received. Please also indicate if you are a Director or Officer of a for- profit corporation and the name of the corporation. I continued on a se arate sheet, lease check here: 0 Name and Address of the Source Nature of Work of Outside Income Performed Breffni Academy of Irish Irish Dance Instruction Dance, Inc. (same as above) * Director of corporation Work Telephone: 305-532-6401, ext. 3033 Apt. # Amount of Money or Com ensation Received $ 0 for YE 2004 National Foundation for Irish Dance Instruction $ 675 for YE 2004 Advancement of the Arts 800 Brickell Ave, Miami, FL State of Florida Irish Dance performance $ 879 for YE 2004 200 E. Gaines St, Tallahassee, FL OUTSIDE EMPLOYMENT INFORMATION OUTSIDE EMPLOYMENT means the providing of services or capital, other than to HACOMB, or to the respective municipality, with the intent of earning a profit or income, including but not limited to, being an employee, an independent contractor, an agent, or by self- employment. FILING INSTRUCTIONS This form must be filed by July 1 st of each year. The form should only be filed by employees who have outside employment or are an officer or director or shareholder of a for-profit corporation. HACOMB personnel shall file completed forms with the Human Resource Department.