Ortiz, Sandra
_DADEt
OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
FULL-TIME COUNlY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY
1 ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1 (K)(2) OF
THE MIAMI-DADE COUNTY CODE.
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First
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Disclosure for
Tax Year Endirig:
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Middle
Name: Last
Filing as a (check one):
D Miami-Dad~ County Employee
D Municipal Employee of: C.l~ n+ yV\ , a. Wl, &a (' ~
Position Title:
N\, L
If your home address is exempt from public records pursuant
to Florida Statutes S 119.07, please check here: D
Mailing Address (Street Name and Number)
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73-70
(;'58'
7J96
Apt. #
Work Telephone:
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City
State
FL
Zip Code
331 if
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
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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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10126100