Ireland, Donnovan C. 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
2 Disclosure for
~ ~
) OF
1 ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)( Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
Name: Last First Middle
~~
Filing as a (check one): ^ Miami-Dade County Employee
^ Municipal Employee of: ~ ~ /~
Position Title:
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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: ^ ` ,-- _ ~
Mailing Address (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
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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