Cuervo, Carlos Aurelio 5~
M „~, OUTSIDE EMPLC)YMENT STATEMENT
^ For Fuli~ime County and Muniapai Empfoytaes
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E1~IF'I.OYWEN? IIAUST FILE MI ANNl1AL OIECLOB<JItE REPORT BY JULY Dbciosure fOf n
1sT OF FJVC;H YEAR W A1XiORWWCE WITH 3ECTi0N 2-11.1(11)(2) OF Tax Year Ending: ~"
TFE Mtn~n-Or~oe Ca~'nr Goof.
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C~cwrfi~fNwn C,otuttylMurtidpal Division:
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if yrwr hwne address ~ exem~ horn public retards prasuanf
to Fbrida Statutes § !19.07, pl~se t~edr hers: ^ Wa'k Teleplwne:
3OS ' ~0 73 " ~~~
Mailing addre~ (Street Name arxt Number) Apt. aR
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State Tip ('.ode
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Please list the aauroes of outside arrlployrrlent. the nature of the vwric and the amounts of money a dher
o~ You received. if oorrtinued on a separate sheet, pJieese check bane: ^
Name and Addrosrs of the Source of Nature of the tlYofk
Pertofined Amount of Money or
t:omPenr~ion Received
Outside income
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I her+~y swear (or a(tim,) ttWat the a~'oresaid infomaation i$ a true and correct statement.
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