HomeMy WebLinkAbout7/28/2017 - Municipal Elected Official Outside Concurrent Employment Annual Disclosure FormBROWARD COUNTY ELECTED OFFICIAL CODE OF ETHICS OUTSIDE/CONCURRENT EMPLOYMENT
DISCLOSURE FORM FOR MUNICIPAL ELECTED OFFICIALS
Name of Elected Official:
Calendar year covered by disclosure form: o3D j<
Name of outside or concurrent
Remuneration received
Direct employer contributions to
employer
during covered year
retirement
Please state exact amount or check applicable box
r.1 under $1,000
n $1,000-$5,000
Did you receive any direct employer
contribution to retirement from this
rl $5,001 - $10,000
employer during the reporting period?
rl $10,001 - $25,000
E]Yes Blqo
B125,001 - $50,000
If yes, was this amount incuded in the
ni $50,001 - $100,000
exact remuneration amount or range
rl Over $100,000
disclosed in the prior column?
Exact Amount
rlYes n No
sa',�&'rj
n Under $1,000
F1 $1,000 - $5,000
Did you receive any direct employer
contribution to retirement from this
Oe-S -11-t--
0 $5,001 - $10,000
$10,001 - $25,000
employer during the reporting period?
rjYes
$25,001 - $50,000
If yes, was this amount incuded in the
50,001 - $100,000
exact remuneration amount or range
E) Over $100,000
disclosed in the prior column?
Exact Amount
[]Yes EINO
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?
El $10,001 - $25,000
[]Yes []No
El $25,001 - $50,000
If yes, was this amount incuded in the
[] $50,001 - $100,000
exact remuneration amount or range
E] Over $100,000
disclosed in the prior column?
n Exact Amount
[]Yes []No
Signature of Elected Official: //OJZ 1h Date: V2-a/�/7
If this form mRemils a previously-fige* form, please check this box
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