Rios, Jorge
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OUTSI.DE 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 V\IITH SECTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
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Name: Last
Filing as a (check one):
D Miami-Dade County Employe~ , f1
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.0- Municipal Employee of: . ( VI V.-> I
Position Title:
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CountyJMunicipal Department . County/Municipal Division:
Corx:-U;trpi/l4N CC
If your home address is exempt from public recotds pursuant
to Florida Statutes ~ 119.07, please check here: D
Mailing Address (Street Name and. Number)
Work Telephone:
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Apt. #
City
State
Zip Code,
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 hem: 0 .
Name and Address of the Source of
Outside Income
Nature of the Work
Perfonned
Amount of Money or
Compensatl e ed
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
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Date Signed 0 ._,r'\/
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