Rybalka, Victor
MtAMD
OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
FULl.-TtME C~U AND MUNICIPAL EWLOYEES.ENGAGING IN OUTSIDE
EMPLOYMENT M ST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure for
1ST OF EAC IN ACCORDANCE WITH SeCTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
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o Miami-Oad~ County Employee
~ Municipal Employee of: Jv1/ H-J/'i/ JJ ?-/f~JI
Middle
Name: Last
Filing as a (check one):
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CountylMunicipal Department:
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position Title:
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CountylMunicipal Division:
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Work Telephone:
30..3- b 13~ 1-1t Lf
Apt. #
If your home address ;s exempt from public records pursuant
to Florida Statutes ~ 119.07, please check here: 0
Mailing Address (Street Name and Number)
/ r S E (0 01 . /;..ee I
City ....-;--
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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: 0
vb -e/LP/7-~-e
FA
Zip Code
333/~
State
Name and Address of the Source of
Outside Income
Nature of the Work
Performed
Amount of Money or
Compensation Received
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St!..P-Of!'~ pr JVsr/~e
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing
Date Signed
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