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Henry Johnson OUTSIDE EMPLQYMENT 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 Disclosure for 1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending: THE MIAMI-DARE COUNTY CODE. Name: Last ~ ~~ First l-~ ~ Middle Filing as a (check one): ^ Miami-Dade County Employee Municipal Employee of: L I ~~( c`~ r M ~~ 1 ~~ +-~ Position Title: L7~ tc~'~ ~L.{~-n~t~ti 1~--- County/Municipal Department: _ County/Municipal Division: '~c.A+.l a ~,~ ~ rD ~~~T1~~lN 1 if your home address is exempt frr~m public records pursuant Work Telepr• ie: ro Florida Statutes § 119.07, please check here: ^ ~~ ~ ~~_ 3 ~ 7na o ~ (~~q j Mailing Address (Street Name and Number) Apt. # ~~ ~ ~ 213 1 c~ ~ City State Zip Code ~ ~ A-M ~ fit, 33 ~ 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 ~~ N ~ ~ ,( 1 ~ - ~ L U~I~~~Q_.5 17~ ~~JNL ~ (~-~~ss~Z ~ ~ r' D~ III NW I ~3 s ~ ~~, ;-~ ~--~,o N ~h i M l J~'M >, ~L 331 6~ I hereby swear (or affirm) that the aforesaid information is a true and correct statement. Signat a of P Disclosing Date Signed _ ~~~~~~ -`;~ ~~ ,o~ . t ~. ~.l I, _ ~ tii ?.,. I.l GS ~~~`~ 3 ~ Pty ~~ OS OUTSIDE EM~A[~C~'~'IyfE~t~.l$~1ATEMENT MIAMhDADE ~~ For Full-time Coµrtty ar~d Municipal ployees FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY JULY Disclosure for 1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF Tax Year Ending: THE MIAMI-DADE COUNTY CODE. Na e: Last m Firs Middle ~ l fT"' V ~ 5~ ~ ~- ~~~~~ Filing as a (check one): ^ Miami-Dade County Employee Municipal Employee of: CI T\(~ M lA~'-1 ~~l~C,~-1~ Position Title: CountylMunicipal Department: CountylMunicipal Division: If your home address is exempt from public records pursuant Work Telephone: to Florida Statutes § 119.07, please check here: ^ 'j`DS ' (p `3 ~ ~l~O ~~ ~ (9 I ~-~ Mailing Address (Street Name and Number) Apt. # ~'j t N l~ 213 ~7~ C ~ ~ ~' City State Zip Code. ~~ 1 ~,.,,~/1 l 1'lr ~~ I ~ 1 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 AAoney or Outside Income Perfor med Compensation Received ~xar•t-"~ 1~1T~L. Uti,~1. p /~'P~~t~~"f 1'?.~,Sc`~ ~ Z~~~.~~ ~}~ 111 ~ 4~ 1~~ s ~ ~ 5v I ~ ~ ~~~ n7 I.~rn1 F~ 3 ? ~ 6~ I hereby swear (or affirm) that the aforesaid information is a true and correct statement. Sig erson '~ to ' Date Signed ~~) of • '~ ~ ~ ~; ~-~~~~?1~~~1 1 ~Tr~T~:~~1~~1' Oh ?~03 ~.'L. ~rnt~rnpry_~oinam~ ~nai;iny T T ~ i v ~ FIB ~i'~~ C IAL I ~~I'FRF ~T .,~,, ~ , ,,:;~,,,- ~~,~ ricsu;on r~l~w ,, , __ 1,~~6T hA' 9i. -- F'RST Nr..f,lE -- !/ti!~ U~" Nr;ME . FOR OFFICE ~~G]©~ ~~I USE ONLY: I ~~ l_~VW HIV I I y VV ~ 'G~1 }C~ ~ ~ f"i -- - ID ~u~_ ~j ~-~~ CI ~ Y : ZJP : COUNTt' ID No. 1~ I~/1 - c, 33 ~l-~-nJ + `SID,: IJ-,~:',i_ of ~,~~NC'~ l ~~ ~ ~ ~ ~ ~ ~~~ Conf i;oae / H t O R SOUGH T ~ P F'eq Code !~L,;.iE- U}- CIF I ICE OI< POSITIGN L 'u A ~ ~ 1 ~ ~ ~ CHECK IF ~ CANDIDATE 0~2 ~ fJE1~r EMPLOYEE OP.APPOIN?EE PDF 20D3 "THIS SECTION MUST BE COMPLETED" DISCLOSURE PERIOD: THIS STAi EPAENT REFLECTS YOUR FINANCIAL INTERESTS FUR THE PRECEDING TAX YEAR,'JVHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL Y AR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR EtJCING EITHER (check one]: DECEtV1BER 31.2003 OR ^ SPECIFY 7AX YEAR IF OTHER THAN THE CALENDAR YEAR: PAANN R OF CALCULATING REPORTABLE INTERESTS: 'i-~c :ECVSU~TURE .AL!.U'VdS FILERS THE OPTiUN UF' USiIJG REPORTIfJG T}iRESHULDS THAT F+nE ~=.F3SCLUTE DULLAR VALUES, 6NLiICH I<FVUiRES FE'JVER CALCULATIONS OR U51NlU COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED itJ PER_.ENTAGE VALl1ES (gee 1st!,ychun<, for tunher Ue?ails? PLEASE STATE 6ELUVV NJHETHERTHIS STATEMENT REFLECTS EITHER (che;.k one): [~~{ ~~Ot~1PARATIVE (PERCEtJIAGE} THRESHOLDS UR ^ DOt LAR VALUE THRESHOLCS PAR~i A -- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person) NAIv"E OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCUtVIE ADDRESS PRINCIPAL BUSINESS ACTIVITY C ~ I o c~ ail' ~~ ~~ ~,n ~ S~c~ PART d -- SECONDARY SOURCES OF INCOME [t,4ajor customers, clients: and other sources of income to businesses owned by the reporting person] NAh1E OF NAME OF t.9AJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSWr.~ S ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE 1Z1p.I1 1 {N1T'L UNi~. ~ G t,J - i 111 f~la\( ~'~ ~i) UI~1~~511 PART C -- REAL PROPERTY [Land, buildings owned by the reporting person) FILING INSTRUCTIONS for when and whore to file this form are locat- ed at the boftorn of page 2. INSTRUCTIONS on who must fife this form and how to fill it oui begin on page 3. OTHER FORMS you may need to file are described on page 6. CE FORM 1 - Etf. 112004 (Continued on reverse side) PAGt t r'Aii't C) w'TF,f IE3LE PEriiON.AL Pi•'uPEkiY ~ - -~~ r~'~~ .. Iii; F :, - ~c. -n _ _ ___~if>LL {.-__-- .mac tf., ~r l.': f-i i, -._i-ice f-;jt_ PART E -LIABILITIES li."aJor r±eb; ; ~I-~,f~9E uF ~:RFG~1pF{ - -~-_ r~D.)F LSS ~_1F CRED,T:=~R PART F -INTERESTS IN SPECIFIED BUSINESSES IOwnersh p c; pos,UCr~s ~.~ certain types cf husiness~s] Qt,'SiNESS E'dTITY # ~ ~ `?'JSIN=SS ENTiT`r' ~ 2 TY NTER~ST a~ , SLSINESS EN?ITY ~ 3 IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE SIGNATUP,E WHAT TO FILE: ~ niter carnpieting all parts o this forrn, incl~dir,g s~yr.ing and datiny it, send back only life first sr~cet {payer 1 and 2) for Glint'. NOTE: MULTIPLE FILING UNNECESSARY: Generally, a person who has filed Form 1 for a calendar or fiscal year is not required to file a second Form 1 for the same year. However, a candieate who previously filed Form 1 because of another public position must at least fife a copy of his or her onginal Forrn 1 when qualifyiny CE FORPA 1 - Eff- 1'2004 1' [LI1rC; 1NSTR[TCTIUNS: WHERE TO FILE: If you were marled the form by the Cornrnission on Ethics or a County Supervisor of Electrons for your annual disclosure filing, return the form to that location. Local officersremployees five with the Supervisor of Elections of the county m which they perma- nently reside. {If you do not permanenNy reside in Florida, file with the Supervisor of the county where your agency has its headquarters.) Slate officers or specified state employees file with the Commission on [lhics, PO. Drawer 15?Q9. Tallahassee, FL 323? 7-5709. Candidates file this forrn together tiwith their qualifying papers To de(errnine what category your position falls under. see tRe "U'Jho fVlust File" Instructions on page 3. DATE SIGNED (required): ~ lj,~/~~ WHEN TO FILE: /nitiagy, each local officer/employee, state officer, and specifed state employee must Lle within 30 days of the dele of his or her appointment or of the beginning of er7rploy- ment. Appcintees who must be confirmed by the Senate must file prior to confurnation. evc-n if that is less Than 30 days from the date of their appointment. Candidates for publicly-elected local office must file al the same time they file their qualifying papers. Thereafter, local officers/employees, state officers, and speci5ed stale employees are required to five by July 1st fcllcwh,g each calendar year in which lney hold their pest bons. Finally. at the end of office or employment, each local off~ceriempioyee, state officer, and specified state employee is required to file a final disclosure forrn (Form 7 Fj within GO days of leaving o`fice or emplcvment PAGE 2 Mt~i~ SOURCE OF INCOME STATEMENT Please Print or Type First Name Middle Name Inlt~al t.asi name Disclosure ^~ For Tax Year Name: E ~ ~~ Ir0 !~'~ ~ ~ Ending: L -~ ~_ Mailing Address: ~) 2 i t " ~ a~ L~ ~ ) City/State/Zip: ~) ~, + ~. ~- ''?~ ~ ~~ ., _ Social Security Number: c ~~ ~' ~ ~ 7 ~~ `~ ~~ Filing as a: ® County Employee: ~-,Municipal Employee of: (~ ~ ~~I i ~ ~]~a-} Position held or sought: 7"L f-~-r~l.~ ~ `~~- Board where serving: ~---- Term or Employment Began on: Department where employed: t ~._prl~ !`' ",'"~' ~`~ ~' 1 ~i" ~ Work Address: f ~`~ ~,4Y~1 ~ ~ ~~~' ~ f- ~- `~ ~ c_> ~~ ~( If your home address is exempt from public records pursuant to Florida Statutes § 119.07 please(check here (read instructions): ® Work Telephone: Home Address: ~r' ~ ' ~7 `2 % ~`~~ (~ ` ~ ~. (,- _ i ~~ 7~ ' - ~ ~,^~J i ~ ~y ~ { Street Address -~_ City State Zip Code Please list below in descending order with the largest source first, the name, address and principal business activity of every source of your income including public salary you '~ received or any person received for your benefit or use during the disclosure period. The income of your spouse or any business partner need not be disclosed. If wntinued on a separate sheet, check here: (or affirm) that the aforesaid information is a true and correct statement. person f r Date signed