Gruen, Michael
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OUTSIDE EMPLOYMENT STATEMENT"
For Full-time County and Municipal Employees
Name: Last
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First
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FULL-TlME 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:
THE MIAMI-DADE COUNTY CODE.
Middle
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Filing as a (check one):
Position Title:
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County/Municipal Department:
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If your home address is exempt from public re~ursuant
to Florida Statutes ~ 119.07, please check here: tyj
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CountylMunicipal Division:
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Work Telephone:
Mailing Address (Street Name and Number)
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City
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MS- -G '13-7
I 6W 972-
Apt. #
State
" Zip Code
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'5313
Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. "continued on a separate sheet, please check here: 0
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.
Signature of Person Di~l~g
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Date Signed
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10126/00