Outside/Concurrent Employment

2. Broward County Code of Ethics Disclosure Form

4. Miramar Elected Official

6. Outside/Concurrent Employment

8. For an annual period beginning and ending
   For an annual period beginning and ending Start Date

   For an annual period beginning and ending Start Time

   —

   For an annual period beginning and ending End Date

   For an annual period beginning and ending End Time

10. Name of Outside or Concurrent Employer/Employment
    Please include both the name of the employer and position held.

    Please include both the name of the employer and position held.

11. Remuneration or Payment Amounts Received in Prior Year

25. eSignature

27. Acknowledgement of Receipt

29. City Clerk

30. Date
    Date

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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