Walthour, Bertran IAMhDADE OUTSIDE 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 c~
1 ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending: ~ ° ~}
THE MIAMI-DADE COUNTY CODE. _. ~, ,,.~.~
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Name: Last First Middle ~ N
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Filing as a (check one): ^ Miami-Dade County Employee ~
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unicipal Employee of: ~~ ~/_~_~.~w`! 1~4C ~
Positio
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Title:
11
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County/Municipal Department: County/Municipal Division:
If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ^ _ ~ '~ ~ , ~~l
Mailing Address (Street Name and Number) Apt. #
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Cry 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: ^
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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