Avalos, AdrianM~~~ OUTSIDE EMPLOYiIIlENT STATEMENT
For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUN(CiPAL EMPLOYEES ENGAGING !N OUTSIDE
EMPLOYMENT MUST PILE AN ANNUAL DISCLOSURE REPORT 8Y JULY
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF Disclosure for
THE MtAMi-DADE COUNTY CODE. Tax Year Ending:
Name: Last First
Middle
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Filing as a (check one): ~ Miami-Dade County Emplo ee "~
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Municipal Employee of: ~ ~
Position Title:
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County/Municipal Department: ° ~ iN
County/Municipal Division: c=1
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If your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119. d7, please check here: ® .. A
Mailing Address (Street Name and Number) 3oS "6 /3~ ~~~ - `O yY
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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
Outside Income
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Nature of the Work
Performed
Amount of Money or
Compensation Received
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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