Bruder, Jasone ,
RECEI,V~C~
niN 3 0 2008
OUTSIDE EMPLOYMENT STATEMENT By
MIAMw
~~ For Full-time County and Municipal Employees Time
FULL-TIME COUNTY AND MUNICIPAL EMPLOYEES ENGAGING IN OUTSIDE
EMPLOYMENT MUST FILE AN ANNUAL DISCLOSURE REPORT BY .JUtY Disclosure for
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1ST OF EACH YEAR IN ACCORDANCE WITH SECTION 2-11.1(x)(2) OF Tax Year Ending: O
THE MIAMI-iaADE COUNTY CODE.
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FiNng as a (check one): ^ Miami-Dade County Employee
Muniapal Emptayee afi:: GI`~ 4 ~ M «M 1 ~~
Position Title:
County/Municipal Department: CouMy/Municipaf Division:
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If your home address is exempt from public records p uant Work Telephone:
to Florida Statutes § 119.07, please check here: ~ ~js-6-73_?~~~ ~ ~ ~ 383L
Mailing Address (Street Name and Number) ~• ~
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City State ZP Code
Please list the sources of outside employment, the nature of the work and the amourrts of money w other
compensation you n3ceived. tf continued on a separate sheet, please check here: ^
Name and Address of the Source of
Outside Income Nature of the Work
Performed Amount of Money or
Compensation Received
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1 hereby swear (or affirm) that the aforesaid information is a true and correct statement.
Signature of P n Disclosing Date Slgned
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