Freedline, Lori OUTSIDE EMPLOYMENT STATEMENT
MIAMFDADE
~~ 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
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Disclosure for
Tax Year Ending: ~
THE MIAMI-DARE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee
Municipal Employee of: ~ ~ "`~~ • ~ c~~~~/
Position Title:
C'~~~C~.~ S•~~'r
partment:
County/Municipal D
e County/Municipal Division:
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If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ^ ~ L~~J (~ 7 z~ ~ ~ ~ cr
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. !f continued on a separate sheet, please check here:
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.
Signatu e o erson Disclosing Date Signed
/
10!28/00