Zeigler, JamesMIAMFDADE OUTSIDE EMPLOYMENT STATEMENT
~ For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE /`
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EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY ,JULY Disclosure for j
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1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF 46~
Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
Name: Last
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Filing as a (check one): ^ Miami-Dade County Employee "'~ c.
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Municipal Employee of: C~ ~ ( of
Position Title: _
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Coun~Municipal Deent: ~~
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~ County/Municipal Division: ~ ..,,_
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If your home address is exempt from public records pursuant
to„Florida Statutes § 119.07, please check here: ~ Work Telephone:
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Mailing Address
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Street Name and Number)
Apt. #
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City State Zip Code
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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 sc ing Date Sig ed
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