HomeMy WebLinkAbout6/28/2017 - 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: k(Lkdk--71 Gom-e'?-
Calendar year covered by disclosure form: C;Uce
Name of outside or concurrent
Remuneration received
Direct employer contributions to
employer
during covered year
retirement
Please state exact amount or check applicable box
Under $1,000
Did you receive any direct employer
3& U-
$1,000 - $5,000
contribution to retirement from this
employer during the reporting period?
-tl
$5,001 -$10,000
ties
$10,001 - $25,000
[]Yes []No
d25,001 - $50,000
UT
If yes, was this amount incuded in the
Er$50,001 - $100,000
exact remuneration amount or range
Over $100,000
disclosed in the prior column?
Exact Amount
[]Yes [:1 No
j6'dkLM'6L
Under $1,000
El $1,000 - $5,000
Did you receive any direct employer
contribution to retirement from this
$5,001 - $10,000
employer during the reporting period?
- $25,000
[]Yes [] No
W10,001
$25,001 - $50,000
If yes, was this amount incuded in the
$50,001 - $100,000
exact remuneration amount or range
Over $100,000
disclosed in the prior column?
UN
0 Exact Amount
E]Yes rINo
Under $1,000
Did you receive any direct employer
- $5,000
contribution to retirement from this
WU
$5,001 - $10,000$1,000
employer during the reporting period?
uu.>.
$10,001 - $25,000
nYes nNo
LUOI.-
rl $25,001 - $50,000
If yes, was this amount incuded in the
[1 $50,001 - $100,000
n Over $100,000
exact remuneration amount or range
disclosed in the prior column?
Exact Amount
[]Yes n No
Signature of Elected Official:- Date:
VAJ
If this form amends a previously filled form, please check this box