Kelley, Walter07-23-07A,11~48 RCVD
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 .IDLY
Disclosure for
1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF Tax Year Ending
THE MIAMhDADE COUNTY CODE.
Name: Last First Middle
~i
Filing as a (check one): ~ Miami-Dade County Employee
,~Muniapal Employee of: `(- ~2A~ ~A.t ~~
r
Position Title:
County unicipal Department: Counry/Municipal Division:
~~
!f your home address is exempt from public records ursuanf Work Telephone:
to Florida Statutes § 119.07, please check hens: ~ ~~ ~
Mailing Address (Street Name and Number) Apt. #
v~ao rJ~ fie.
Ciry State Zip Code
~- 3
Please list the sources of outside employment, the nature of the work and the amounts of money or other
compensation you received. !f 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
f~ ~ FL 33 ~ to`'?
r,
~C r
2~r
n
r
• ~..
~ ~ .~
vi
a 3
1 hereby swear (or affirm) that the aforesaid information is a true and correct statement. .,~.t ~ ,
-...
Signature of Person Disclosing Date Signed
4~
~ ~
7 _~ ~-o~
%{3`
~""1
77
..
r
~~