HomeMy WebLinkAbout6/23/2021 - Elected Official Outside Concurrent EmploymentBROWARD COUNTY ELECTED OFFICIAL CODE OF ETHICS OUTSIDEICONCURRENT EMPLOYMENT
DISCLOSUR ORM FOR MUNICIPAL ELECTED OFFICIALS
Name of Elected Official:
Calendar year covered by disclosure form: 1--)
Name of outside or concurrent
Remuneration received
Direct employer contributions to
employer
during covered year
retirement
Please state exact amount or check applicable box
El Under $1,000
Did you receive any direct employer
n $1,000 - $5,000
contribution to retirement from this
0 $5,001 - $10,000
employer during the reporting period?
$10,001 - $25,000
ElYes 0 No
$25,001 - $50,000
If yes, was this amount incuded in the
$50,001 - $100,000
exact remuneration amount or range
rl Over $100,000
disclosed in the prior column?
0 Exact Amount
[]Yes E]No
E] Under $1,000
Did you receive any direct employer
$1,000 - $5,000
contribution to retirement from this
$5,001 - $10,000
employer during the reporting period?
}� �L
® $10,001 - $25,000
E] Yes [] No
/lJ /'
n $25,001 - $50,000
If yes, was this amount incuded in the
rl $50,001 - $100,000
exact remuneration amount or range
Over $100,000
disclosed in the prior column?
Exact Amount
DYes rINo
® Under $1,000
Did you receive any direct employer
® $1,000 - $5,000
contribution to retirement from this
$5,001 - $10,000
employer during the reporting period?
dll�
n $10,001 - $25,000
[]Yes 0 No
n $25,001 - $50,000
If yes, was this amount incuded in the
$50,001 - $100,000
exact remuneration amount or range
0 Over $100,000
disclosed in the prior column?
E] Exact Amount
[]Yes [] No
Signature of Elected Official: ;1� Date: 6
If this form amends a previously filled form, please check this box