Prentiss, Evan Scott~EPr.
MI~~ __„
OUTSIDE EMPLOYMENT STATEN '
For Full-time County and Municipal Employees
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT 8Y .IULY
1ST OF EACH YEAR iN ACCORDANCE WITH SECTION 2-11
1(x)(2) OF Disclosure for
.
THE MIAMI-DADS COUNTY CODE. Tax Year Ending:
Name: Last 1
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S~ First Mpiddle
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FlFing as a (check one): ~ Miami-Dade County Employee
Municipal Employee of: __ ~~`~f c' ~ ~e a R^ t ~Pc G~
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Prosition Title: ~/
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County/Municipal Department: County/Municipa! Division:
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If your home address is exempt from public records rsuant Work Telephone:
to Florida Statutes § 119.07, please check here: ,3Os ~ ~. 3 ~ ~ ~,
Mailing Address (Street Name and Number) Apt. #
City State Zip Code
Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you nrceived. if continued on a separate sheet, please check here:
Name and Address of the Source of
Outside Income Nature of the Work
Pertormed Amount of Money or
Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of P i 'ng D
a
te igned
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