Simon, Douglas E.MIAMFDADE OUTSIDE EMPLOYMENT STATEMENT
~ 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
1 ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11
1(K)(2) OF Disclosure for
J
. Tax Year Ending: s:
THE MIAMI-DADS COUNTY CODE.
Name: Last First Middle
/---'
Filing as a (check one): ^ Miami-Dade County Employee
,,"Municipal Employee of: ~~/.~ ~ i ~~~ c,
Position~Ti-tl~e:
County/Municipal Department: County/Municipal Division:
Ate.. /'~/ - ~ `~ ~/ / .~ 6~ L~' i~ C_., l"'` ~
/f your h me address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check henei~
Mailing Address (Street Name
and Number) Apt. #
~
City State Zip Code
~' r-- ,
~~
~~ ,~ ~~ r~ f~s~ ~
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
/~`~
~d . ~u 3 ~ ~' 9-7 ~ ~
,
,
d
c
„_ ~ -
~:
s -~
~, ~
~~ rv
~, ..
~.
I hereby swear (or affirm that the aforesaid information is a true and correct statement. co
gnature of P rson isclosing Date S~ ned
iorzsrao