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Pereny, Charles A.Mao-aaoE OUTSIDE EMPLO~'MENI' STA77:MEN'T R E(; ~ I ~/ ~ ~ _~ For Full Tnne County and Mumapal Employees CITY CLERK'S DEPT. Please Print or Type Name : ~ ~ ~/ Disdosnre for T~ Year Eading: a' ~ del ng~' IDLE Social Sccurity Numbcr: ~ D ~ ` ~ ~ ~j ~- Filing as a: ~ County F.mployec Municipal Employcc of: County/Municipal Position: CountylMuaidpal Department: ~ N a --1 0 -~ ~ ~7 ~? ~ r~7 ~ ~ ~~r;~p~,P`~2 ~' o ;TI u~ x. ~~~ Division: ~SCc~~- ~c ~~--:~ -•, .. ~,,, Work Address: jD 0 car C c./dfe.,< </~ ~0~ ~~ ~ S ffyour home address is exempt from pub ' pursuant to Florida Statutes 119.07 please check here: work Telephoac: ?ds ~p 7~ ` ~( ~~ Home Addncss: ~~ - ( ~(~/ /~C~:~/~ ~ ,~. . ~/-~ ~`~` L~ ~e fL ~~ 3 CtIY STATE 2IP CODE list below the source(s) of outside cmpioyment, the nature of the work and the amounts of moncy or other compensation you ncctived. If continued on a separate sheet'.clacck hen: p NAME AND ADDRESS OF TIC SOURCE OF OUTSIDE INCOME NATURE OF WORK PF~~RI1~~ AMOUNT OF MONEY OR C011~ENSATiON RECEIVED ©~<< d~ ~~~ ~~ ~ 2S~ © 2 CI ~ j~ S ~~- 1a c') ~rl`- ~~~~1~ ~~ 3Z ~ I hereby swear (or affirm) that the aforesaid information is a trot and cornct statcmcnt. Da c Sigacd