Whitehead, Philip
.,. 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 ~ ()O!i
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
Name: Last leh .11 First Middle
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Filing as a (check one): D Miami-Dade County Employee f3epc~
~nicipal Employee of: C ;.r;. of 121,: a flti
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Position Titl(:;" G/4~(,'CtP1Ce Ol{:-cer
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CountylMunicipal Department CountylMunicipal Division:
If your home address is exempt from public feCOIds pursuant Work Telephone:
to Florida Statutes ~ 119.07, pleas9 check here: ~ J('}~ -6 7 3 -7c1('0 e'ICf 6
Mailing Address (Street Name and. Number) 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 here: D
Name and Address of the Source of Nature of the Work Amount of Money or
Oul$ide Income Perfonned Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
sg~~n~~~ Date Signed
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