Tellez, Elena B.
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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: 0( 60 ,
THE MIAMI-DADE COUNTY CODE.
Name: Last;
e'L
First
Middle
15
Filing as a (check one):
D Miami-Dade County Employee
~ Municipal Employee of:
Position Title:
I;J 15" 7R-11-
County/Municipal Department:
D .JL-
County/Municipal Division:
fL-t:..-
If your home address is exempt from publiC reco~rsuant
to Florida Statutes S 119.07, please check here: l.:::.J
Mailing Address (Street Name and Number)
Work Telephone:
30S--071-7/
o
Apt. #
c23()o
City
MJ
f' 11.JL lICE- L
j)fl
c>H
State
FL
Zip Code.
3.3/ i i)
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
N l/l;- N J,. b Prl> t-
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature 0
Date Signed
--7 'os
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