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EXHIBIT H
CITY OF MIAMI
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F PUBLIC DISCLOSURE OF FINANCIAL INTERESTS
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c' IN COMPLIANCE WITH MIAMI CITY CODE SEC. 2- 619)
Note: As an alternative to the requirements set forth in the above-cited Code Section, a copy of the reporting
person' s filed return for the current year' s federal income tax return may be provided.[ City Code Sec. 2- 619( b)]
LAST NAME
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FIRST NAME MI
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OFFICE HELD
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MAILING ADDRESS CITY ZIP CODE COUNTY
DESCRIPTION VALUE Please list below the name and address of every person,
whether individual or corporation, to whom you owe a-
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1/ 3)00..0
NaAme/ Address of Creditors t Owed
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HOUSEHOLD GOODS/ PERSONAL EFFECTS
Note: You are not limited to the space on the lines in this form. Attach additional sheet( s) if necessary_.
Net worth is the difference between total assets and total liabilities. Please refer to Miami City Code Sec. 2- 619( a- d) when
determining this amount. Enter your net worth as of December 31st of the preceding tax year.
PART D] -- AFFIDAVIT
The information disclosed herein and on any attachments hereto is true and correct to my knowledge.
d./ AL./
ignature o e Person Reporting
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Date
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State of Florida
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Sworn to( or affirmed) and subscribed before me on this the I day of J IA\
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by:
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Name of person signing and his/ her title( public officer, trustee or personal representative)
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WITNESS my hand and official seal.
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Signat a of No , ry Public
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Name of Notary Typed, Stamped or Printed)
Notary Public, State of Florida
NOTARY PUBLIC
El Produced identification:
Type of Identification Produced) , —_. — — —_...— — — —•
iii c"r,••. TODD B HANNON
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