HomeMy WebLinkAbout6/30/2017 - 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:- )'0
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
E]
$1,000 - $5,000
$5,001 - $10,000
contribution to retirement from this
employer during the reporting period?
n
$10,001 - $25,000
nYes JkNo
rl
$25,001 - $50,000
If yes, was this amount incuded in the
R$50,001
- $100,000
exact remuneration amount or range
F1
Over $100,000
disclosed in the prior column?
E]
Exact Amount
E]Yes nNo tjk
E]
Under $1,000
Did you receive any direct employer
El
$1,000 - $5,000
contribution to retirement from this
cr
El
$5,001 - $10,000
employer during the reporting period?
WN 0
46 <
El
$10,001 - $25,000
[]Yes E]No
�e
El
$25,001 - $50,000
If yes, was this amount incuded in the
t3�
zi Uj cr_
ILI
rl
$50,001 - $100,000
exact remuneration amount or range
C) W U
n
Over $100,000
disclosed in the prior column?
M QW>-
Q
Exact Amount
E]Yes DNo
E]
Under $1,000
Did you receive any direct employer
r.)
Q
$1,000 - $5,000
contribution to retirement from this
Q
$5,001 - $10,000
employer during the reporting period?
0
$10,001 - $25,000
RYes nNo
EI$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?
El
Exact Am
FlYes No
'7
Signature of Elected Official: Date: 00 1 g-5\1 L'/11j
If this form amends a previously kd-form, -please check t /is box F1