Martell, James A. OUTSIDE EMPLOYMENT STATEMENT
MIAMhDADE
~~ 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
1 ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(K)(2) OF Tax Year Ending:
THE MIAMI-DADE COUNTY CODE.
Name:
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,
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Filing as a (check one): ^ Miami-Dade County Employee
99
Q'~llunicipal Employee of: f~'tV'~°I ~ ~ 1G;JYl 1 c~lln
Position Title:( '
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County/Municipal Department: County unicipal Division:
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if your home address is exempt from public records pursuant Work Telephone:
to Florida Statutes § 119.07, please check here: ^ ~ ~,-~ ~ L."2 3 ..~ L t~
Mailing Address (Street Name and Number) Apt. #
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City - ., State Zip Code.
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Please list the soun:es of outside employment, the nature of the work and the amounts of money or other
compensation you received. -f continued on a separate sheep please check here: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
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I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of Person Disclosing Date Signed
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