HomeMy WebLinkAbout2/1/2018 - Municipal Elected Official Outside Concurrent Employment Annual Disclosure FormBROWARD COUNTY ELECTED OFFICIAL CODE OF ETHICS OUTSIDE/CONCURRENT EMPLOYMENT
DISCLO URE FORM FOR MUNICIPAL ELECTED OFFICIALS
Name of Elected Official: Oh
Calendar year covered by disclosure form:
Name of outside or concurrent
Remuneration received
Direct employer contributions to
employer
during covered year
retirement
Please state exact amount or check applicable box
ALj
Under $1,000
Did you receive any, direct employer
to
[ $1,000 - $5,000
contribution retirement from this
n $5,001 - $10,000
employer during the reporting period?
$10,001 - $25,000
OYes RNo
n $25,001 - $50,000
If yes, was this amount incuded in the
50,001 - $100,000
exact remuneration amount or range
Q Over $100,000
disclosed in the prior column?
Ej Exact Amount
[]Yes []No
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?
Q $10;001 - $25,000
®Yes rLI, No
® $25:00.1 - $50,000
If yes, was this amount incuded in the
exact remuneration amount or range
0Over $100,000
disclosed in the prior column?
r Exact Amount
MYes rINo
_ wa'
n Under $1,000
Did you receive any direct employer
t
n $1,000 - $5,000
contribution to retirement from this
ra►O t�
n $5,Oo1 - $10,000
employer during the reporting period?
$10,001 - $25,000
[]Yes n No
N
$25,001 - $50,000
If yes, was this amount incuded in the
Q $50,001 - $100,000
exact remuneration amount or range
Over $100,000
disclosed in the prior column?
Exact Amount
[]Yes []No
Signature of Elected Official: �c�f-- Date:g 1
If this form amends a previously fille form, please check this box