HomeMy WebLinkAboutJeffrey R. Wasserman-2024-Outside Concurrent Employment 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:_______________________________
Remuneration received
during covered year
Direct employer contributions to
retirement
Under $1,000
$1,000 - $5,000
$5,001 - $10,000
$10,001 - $25,000
$25,001 - $50,000
$50,001 - $100,000
Over $100,000
Exact Amount _______________
Did you receive any direct employer
contribution to retirement from this
employer during the reporting period?
Yes No
If yes, was this amount incuded in the
exact remuneration amount or range
disclosed in the prior column?
Yes No
Under $1,000
$1,000 - $5,000
$5,001 - $10,000
$10,001 - $25,000
$25,001 - $50,000
$50,001 - $100,000
Over $100,000
Exact Amount _______________
Did you receive any direct employer
contribution to retirement from this
employer during the reporting period?
Yes No
If yes, was this amount incuded in the
exact remuneration amount or range
disclosed in the prior column?
Yes No
Under $1,000
$1,000 - $5,000
$5,001 - $10,000
$10,001 - $25,000
$25,001 - $50,000
$50,001 - $100,000
Over $100,000
Exact Amount _______________
Did you receive any direct employer
contribution to retirement from this
employer during the reporting period?
Yes No
If yes, was this amount incuded in the
exact remuneration amount or range
disclosed in the prior column?
Yes No
Signature of Elected Official:_________________________________
If this form amends a previously filled form, please check this box
Date:______________________
Please state exact amount or check applicable box