Roberts, Mario D OUTSIDE EMPLOYMENT STATEMENT
MIAMw
~~ 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 DIsCIOSUn3 fOr
1ST OF EACH YEAR IN ACCORD~WCE WITH SECTION 2-11.1(I~(2) OF Tax Year Ending:
THE MIAMhDADE COUNTY CODE.
Name: Last First Middle
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Filing as a (check one): ^ Miami-Dade County Employee
Muniapal Employee of: e-- ` l`~ ~/` ~' ~+''~ ~G
Position Title: L_ _
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County/Municipal Department: CouMy/Municipal Division:
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If your home r+ess is exempt from public records pursuant Work Teleph
to Florida Statutes § 119.07, please check here: ^ ~ J ~ ~ . '~
Mailing Address (Stn3et Name and Number) ~• ~
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City State Zip ('.ode
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Please list the sources of outside employment, the nature of the wr,rlc and the amounts of money or other
compensation you received. if continued on a separate sheet, please check hen:: ^
Name and Address of the Source of Nature of the Work Amount of Money or
Outside Income Performed Compensation Received
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1 hereby sw~lr (or affirm) that the aforesaid information is a true and co->'ect statement.
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Signature of Person Disclosing Date Signed
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