Marshall, Wayne EverettMIAMFDADE
~ OUTSIDE EMPLOYMENT STATEMENT
~ For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING tN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY .IULY
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Disclosure for
Tax Year Ending: ~- d O ~
THE MIAMI-DADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee
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Municipal Employee of. c r" ~i~z~"''! i:~~~c=
Position Title:
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County/Municipal epartment: County/Municipal Division:
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If your home address is exempt from public records pursuant Work T lephon :
to Florida Statutes § 119.07, please check here: ^ ~ ~ 5 3 t~~ „ 3 2 7
Mailing Address (Street Name and Number} Apt. #
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State Zip Code.
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: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
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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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