Chambers, Raymond FranklinRECEI,~~p~
JUN 2;,8 2107
MIAMFDADE OUTSIDE EMPLOYMENTTII~ ~
~' For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE Disclosure for ~ p
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT(Bj( JULY Tax Year Ending: ~ ~G
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1 K 2 OF
THE MIAMI-DADE COUNTY CODE.
~~g.~~ First y' A ~ Middle ~
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Filing as a (check one): ^ Miami-Dade County Employee
I.-`~'~Ueicipal Employee of: el / ~ ~~~~~~ ~ ~~~
Pos~n Title:
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County/Municipal Department:
If your home address is exempt from public records
to Florida Statutes § 119.07, please check here:
Mailing Address (Street Name and Number)
City
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County/Municipal Division:
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F Work Telephone:
Apt. #
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 Nat Performed ork Compen at onn Received
Outside Income
1 ~ ~ ~.._ t '3°14 ~ a7'RL~/Ji-~s
V I ~ Y iF`~~~ lv~ (~t?t~l~1~Ir~Y~I~'~` ~yhouNTS VA-7z~~Gs BY
r / S /~ t -Slvc~ - ~r~6~- / y~8 1-~57Y~~ ~ 6
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Date Signed
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