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.
11. Remuneration or Payment Amounts Received in Prior Year
25. eSignature
27. Acknowledgement of Receipt
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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