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Home My WebLink AboutADAMS JEROME 11-06-2012FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY ��) Jerome Adams OFFICE USE ONLY Name �2� 901 Roseland Rd. ��C��/�`� Address (number and street) �QV Z Sebastian, FL 32958 Cjt s��Or2 /\�. City, State, Zip Code Cit y°r eba ❑ CHECK IF ADDRESS HAS CHANGED {3) (D Number: ��e (4) Check appropriate box(es}: ✓0 Candidate (office sought): sebastian City Council ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ EIGCtEi)CiE?eCiCiC� CCiC11Ct1UC1iC��1C)Il [__] CHECK IF NO OTNER ELECTtONEERING COMMUNICATION REPC?RTS WiLL BE FiLED (5) REPORT IDENTIFIERS Cover Period: From 11 / 2 / 12 To 11 / l� / 12 Report Type rx � Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ o. 0 o Expenditures $ 1. 81 Loans � 0. 0 0 Transfers to OfFice Account $ o . 0 0 Total Monetary � 0. 00 Total Monetary $ 1.81 In-Kind � 0 . 0 0 (8) Other Distributions $ o_oo (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 22o.ao $ 220.00 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (TYpe name) � C�(JM � �� N`1S (Type name) j � 1�0 A'� � t-t�,� �'� �J � Ir7dividual (only for Q✓ Treasurer � Deputy Treasurer �✓ Candidate � Chairperson (only for PC, PTY & electioneeriny commun.� ciectioi�eerinc� con�mui�, organization) %C � `� �✓� %� �� Si ture S ature DS-DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS (1) Name Jerome Adams (2) I.D. Number (3) Cover Period 11 / 2 / 12 through 11 / l� / 12 (4) Page 1 of 1 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address & Contributor Contribution In-kind Number Cit , State, Zi Code T e Occu ation T e Descri tion Amendment Amount � ! / /,, � / � ,� 1 1 �OV ?' �' ,r CC� �°f S�� ., �� rk � ��i� -P / / / / / / / I / ! i / f' / DS-DE 13 (Rev. 08/U3) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES (1 } Name (3) Cover Period CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES Jerome Adams (2) I.D. Numbel' 11 � 2 � 1z through 11 / l� / 12 (4) Page 1 of (5) ��) �$) �9) i� �) �� ) Date Fuli Name Purpose �s� (Last, Suffix, First, Middle) (add office sought if Sequence Street Address & contribution to a Expenditure Number City, State, Zip Code candidate) TYpe Amendment Amount Jerome Adams Close Campaign DIS $1.81 11 17 12 901 Roseland Rd., Account Sebastian, FL 32958 1 R j Fi�FO ; , Np� � i� cc'ty �fs 241? : e,-k, � tia,�, : . ��e ', � DS-DE 14 (Rev. Os/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES �/ _ \ CfiYOF �'1�� HOME OF PELICAN ISLAND SEBASTIAN CITY COUNCIL MEMBER OATH OF OFFICE I, Jerome Adams, do solemnly swear that I will support, protect, and defend the Constitution and Government of the United States, and of the State of Florida; that I am duly qualified to hold office under the Constitution of the State; and that I will faithfully perform the duties of the office of Council Member for the City of Sebastian of which I am now about to enter, so help me God. �` � 7.�. Z� r me Adams astian City Council Member Sworn and subscrib d before me this 14t" day of November, 2012. �? �. �' - ; Sally A. io, MMC City C1 r (SEAL) , `_// I ; , ,. � �� _ , . �, U _ - � L.,i �� ,�°,�°- �=� HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org November 2, 2012 Jerome Adams 901 Roseland Road Sebastian, FL 32958 Dear Mr. Adams: In accordance with Florida Statutes Section 106.141, the Termination Report (TR) for your campaign is due within 90 days of the day of the election, which is no later than February 4, 2013. This report will inciude a summary sheet and an expenditure sheet showing the disbursement of all funds. There wili be no contributions sheet in your TR since the last day for accepting contributions was November 15� and those contributions were included in your G4 report. A copy of FS 106.141, which sets out the manner is which excess funds in your campaign account can be disposed, is attached for your information. If you have any questions, please don't hesitate to contact me at 388-82145 or smaio@cityofsebastian.org. Sincerel , �� /%( `\ - �_ �� / �'1/� Sally A. Ma o, MMC City Clerk FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY ��) Jerome Adams OFFICE USE ONLY Name �2� 901 Roseland Rd. r`�C��V�� Address (number and street) Sebastian, FL 32958 N�y a� xo "''� City, State, Zip Code `��y�'�� j ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: �'��' (4) Check appropriate box(es): � Candidate (office sought): sebastian city council ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ Elec�ioneering �omrr�ur€icatiQn C CHECK IF Ni3 OiH�R �LECTNON�ERING . . . . . . COMMUNICATION REP(3RTS WILL BE FlLED (5) REPORT IDENTIFIERS Cover Period: From io / i3 / aola To il / i / zola Report Type G4 � Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks � o. o o Expenditures $ 14 0.17 Loans � 7 0. 0 0 Transfers to Office Account $ 0.00 Total Monetary � 7 0. 0 0 Total Monetary $ 14 0 . 17 In-Kind � 0 . 0 0 (8) Other Distributions $ o.00 (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 220.00 $ 218.19 (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (Type name) Jerome Adams (Type name) Jerome Adams � Individu�( (only for �✓ Treasurer � Deputy Treasurer �✓ Candidate � Chairperson (only for PC, PTY & electic�t�eerirtg cornnouri.j �electiarzeeri�g cornmun. oryanization) X � %�? X ��G�,�' , / , Sign ure Sigta ture DS-DE 12 (Rev. 08/04) CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS ' '' (1) Name Jerome Adams (2) I.D. Number (3) Cover Period 1° / 13 / 2° 12 through 11 / 1 / z o 12 (4) Page 1 of 1 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middie) Sequence Street Address & Contributor Contribution In-kind Number Cit , State, Zi Code T e Occu ation T e Descri tion Amendment Amount Jerome Adams I Computer LOA $60 10 � 16 �2012 901 Roseland Rd., Tech. Sebastian, FL 32958 1 Jerome Adams I Compute LOA $10 10 � 17 �012 901 Roseland Rd., r Tech. Sebastian, FL 32958 2 / � � R'�GE� FD N�V n2 � ;ry c�f D�? ",ty C��ba �a ic@ / / / / / / / / .� DS-DE 13 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED� EXPEND'ITURES � � ��' (1) Name Jerome Adams (2) I.D. Number (3) Cover Period 10 � i 3 � 2 o i 2 through 11 / 1 � 2 o i 2 (4) Page 1 of 1 (5) �7) �8) �9) �� ) (� � ) Date Full Name Purpose �s) (Last, Suffix, First, Middle) (add office sought if Sequence Street Address & contribution to a Expenditure Number City, State, Zip Code candidate) TYpe Amendment Amount Impeccable Signs Signs MON $64.20 10 15 12 832 Doctor Ave., Sebastian, FL 32958 1 Impeccable Signs Signs MON $71.09 10 17 12 832 Doctor Ave., Sebastian, FL 32958 2 Home Depot 2 wooden MON $4.gg 10 27 12 13361 US Hwy 1 stakes Sebastian, FL 32958 3 �,�C� V�� 7 N ��ty c�F ��fY Cle k�� t�an �c� DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES �� 1�� . HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian. org October 22, 2012 Jerome Adams 901 Roseland Road Sebastian, FL 32958 Dear Mr. Adams: In accordance with Florida Statutes Section 106.07, the G4 campaign treasurer's report for your campaign for the period Saturday, October 13, 2012 through THURSDAY, November 1, 2012 is due by Friday, November 2, 2012. This is the 4th day prior to the election and the due date is governed by FS 106. I will be here all day Friday November 2"d until 5 pm to receive your report. I will provide you with the Statutes relating to proper disbursement of campaign funds in your next letter. Please keep in mind that this report is different than the previous three. The reporting period ends on a Thursday, November 1 st and is due the next day on Friday, November 2nd. No further contributions can be accepted after midnight on November 1 St. This means midnight on Thursday night, not Wednesday night. This sometimes causes confusion. (2)(a)1.A1/ reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m, of the day designated; however, any report postmarked by the United States Postal Service no later than midniaht of the day designated shall be deemed to have been filed in a timely manner. Any re,nort received b� the filinq officer within 5 days after the designated due date that was delivered � the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the re.port was mailed after the desiqnated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailing, or a receipt from an established courier comvanv, which bears a date on or before the date on which the report is due, shal/ be proof of mai/ing in a time/y manner Reports sha/I contain information of a// arevious/y unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. If you choose to mail, please make sure the form is completely filled out and signed and you have inserted a USPS mailing receipt. If your report is received incomplete after the deadline, it will be deemed not timely filed and penalties may be imposed. If you have any questions, please do not hesitate to contact me. Sinc�re�y% ;�`� - �-�'o` �`� Sally A. Mai , MMC City Clerk FLQRIDA DEPARTMENT OF STATE DiVISfON �F ELECTIONS CAMPAIGN TREASURER'S REPORT 5�IMMARY ' t�} � � �.�i�'� I�� M � ' OFFIGE U5E �NLY Nat�e ��,�� (�) q,o i '�.c� 5�L,4-N� �� Address (numE�er and streetJ - ----- �� , 5 �.i3 f� s i I �N � f--L � 2- `� S �' - - - � - �'i% �f ,��b �� City, State, 2ig Code ��'�ler1�� l�ri ❑ CH�CK IF ADDRE$8 HA5 CHANG�D (3} ID Num�er: (4} Che�k a�propriate box�es): j �Candidate �oifice sougf►t): �El,�.S�i �n1 �� I ��f� �.i � - - - � — ❑�olifical Cammi�#ee ❑ CHECK IF PC HAS DiSBAND�D ❑ Gammitfee of Continupus �xistence ❑ CHECK IF GCE HAS DtSBANp�D ❑ Party Executive Committee ❑ E�ecti�r�eering Cammunicatior� ❑ CHECK !F IVC} f7TH�R ELEC�"ION�ERI�lG ` ' COMMl11�lCATIORi REFORTS WIiL$E FILEQ - �• • - � (5) R�POR7IQEIVI'IFIERS Ca�er Periad: From � 1�� 1 j� To �t'7 1 1� 1 f Z Report Type �`� �` . .. � � DrEg�nai ❑ Amer�dment ❑ 5�ecial �iectiflr� Report ❑ Inciepe�d�ni ExpendiEure Report �6� CO{VTRIBUTI�NS TH1S REPORT (7) �XP�NpiTURES TH1S REPQRT' Monetary - CasE� & Checks ��] Q Expenditu�es $ J�� (j `� Laans � 'L7 Transfers ta Office Account $ Tatal Monetary � rj�J Total � Monetarj/ $ }7�� '? . En-Kind �► � (8) Other Disiributians � (� - (8} TOTAL Manetary Contributians To Daie ('{0} TOTAL Monetary Exper�ditures To Date � �:�� 7�a�'�. .. . .... .. . ... ._ . �'l1) CERTIFICAitON . It is a firs� degree misdemeanor fbr any �ersQn to falsify a public record �ss. 839.'I3, F:S.) 1 certify that I have examinecf��this repori and it is tru�, I cerEify thai 1 have examined �his repori and ik is true; cor��c�, and com�Iete. correct, and com�lete. � (�v�e narne} �J �t�01`�t � ��1 � (Type name) `5 ��'-� � �-[`J�4�+�1 S ❑Indivfdual {onfy.tor QTreasurer ❑�eputyTreasurer �/ Candsdafe ❑Chairperson{only�orPC,PTY.& eleclioneering cammun.) eleclioneering comrimun. flrgarrizaiidn) � � l 7f??_.0 � i�'/?'�- f�+��i��2.� Si� iure 5ig�.�ure �S-�E 12 (Rev_ a61U4S CAMPAIGN TREASLIRER'S R�PORT -- iTEM(ZED GONTRIBIlTIONS [�) Name J ��,0 �-i7,41�4.5 �2) 1.D. Number (3} Caver Periad -1 I?� 1 r 2- through �J 1 j 2 J j Z {4) Page � of I (�) (�? �8) (�) (� Q) (11:} (12) Date Full Name {6) (Last, SufFx, First, Middfe) • • Sequence SEreei Address 8 Cnntribuior Gontributinn ln-kintf Nurnber Ci , Staie, Zi Code T e Occu ation T e Descri iion Amendment Amaunt �� •Z � � �Z '�� -�2r� '��'r�,a � `�� Surt� � e�� L- � 5� f� �JYI� '�Ci1-��r� Cor�m; SJCs � �� 1' i�TC�� Y�' ' �.. / 1 1 1 � ~� '��64 ,�I7 � � �'� � � � �p� • �► sr �..,: �!� �� & �� 1 I 1 1 ! 1 1 I 1 ! ua-u� �s ��ze�_ ue103) 5E� REVERSE FOR INS�RUCT�ONS Ai�l� CQ�� VALLIES . � CAMFAIGN TREASURER'S REPORT — ITEMIZE� E�PEPVDITURES [1) t+fame J��O �- f�r ' (2) i.D. i�le��rlber (3) Cover Period � 1 �-n� ! � �- thr�ugh � �l f Z I � Z— (4) �age � af � �5) ��) is) �9) �1aj ('11j D�te Fufl Name P�rpose {6} (Last, Suffix, F'irst, MidcEle) (add ofFice saught if 5equerice Street Address & contribution to a �p�ndifure Nurnher Gity, State, �ip Gode candidate) �YP� Amendment Amount ]� i �� f�`�.r�'1��-�.7�� T3�� 52�E�5 . �3 J� � �s ,t,�� 9 "�4��.f�J� s) Nl t� �1 � I�r `'1 � �„ .5�/�.:�.s �i'�'17�F[r .-�� Z4 ''a � � �]��.1��. � t� 2�� v s�� t3�y �� , � Dnl �l J�� . S �'h�s`�a�rr, �`{-- 3 Z� 5� o� sar� ��.".n2 . . . . . . . . . . .. . . . � ��-� ,� -� . �� - �,t��; �� 1� cl�;�;�� 15-�E 1q �Rev, p8103) S�� R�VERSE FaR lNS7REICT�ONS AND GODE VALUES �� fl4J:F� . F�. _.F �"�°sr _,. ' HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian.org October 10, 2012 Jerome Adams 901 Roseland Road Sebastian, FL 32958 Dear Mr. Adams: In accordance with Florida Statutes Section 106.07, the G3 campaign treasurer's report for your campaign for the period September 29, 2012 through Friday, October 12, 2012 is due on Friday, October 19, 2012. All contributions and expenditures for that period must be reported. City Hall is closed for furlough day on Friday, October 19th. During evenings, furloughs, weekends and holidays when City Hall is closed, all entry doors lock automatically, so I will not be here to receive the report on that day. You have from Monday, October 15t" through Thursday, October 18t" to hand deliver your report, however, Florida law allows you to mail the report as long as it is postmarked up to midnight of the due date (October 19, 2012) and you include a USPS issued mailing receipt with the report. I encourage you to hand deliver the report in case there is any information missing. If I receive a mailed report and the report is incomplete, according to the State, it is deemed not timely filed and subject to penalty. (2)(a)1.A1/ reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m, of the day designated; however, any report postmarked by the United States Postal Service no later than midni_qht of the day desi_qnated shall be deemed to have been filed in a timely manner, An� report received by the filing officer within 5 days after the desianated due date that was delivered by the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the report was mailed after the desi_qnated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailin4, or a receipt from an established courier company, which bears a date on or before the date on which the report is due, shall be proof of mailin_q in a timely manner. Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. If you have any questions, please do not hesitate to contact me at 388-8214 or smaio .citvofsebastian.orq. Sin er , �� Sally A. Mai MMC City Clerk . • - FLORIDA DEPARTMENT OF STATE DI\/ISION OF E�.ECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY ��) � bRO M� J'��M S � OFFICE �ECO��V Name E� (2) qo i �iDs�LA-Nn ��. ��T ` 3 201? Address (number and street) City �f � CitY C/� k$� o�� S�t3A-S i►q-N F'L 32�i v g City, State, Zip Code ❑. CHECK IF ADDRESS HAS CHANGED (3) 1D Number: (4) Check appropriate box(es): [✓�Candidate (office sought): �re.�e�,.S`�.i�Yl C�� r1 c+ � ❑ Political Committee ❑ CHECK 1F PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Parry Executive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEER{NG COMMUNICATION REPORTS WILL BE F{LED (5) REPORT IDENTIFIERS Cover Period: From q/ 15 /,Z,p� � To 9� 2g / 2c�/z Report Type �- �, [V�Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report � (6) CONTRIBUTIONS THIS REPORT (7) EXPENDiTURES THIS REPORT Monetary Cash & Checks $ Q Ezpenditures $ � Loans $ � Transfers to Office Account $ (� Total Monetary � � Total � Monetary $ (� In-Kind $ CJ (8) Other Distributions $ (9) TOTAL Monetary Contributions To Date (10j TOTAL Monetary Expenditures To Date $ � oo $ � 1 (11) CERTIFICAT►ON . It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined this report and it is true, I certify that I have examined this report and it is true, correct, and compfete. correct, and complete. (Typename) 3�R1�� E /4�A/�S (Typename) ; ��i�� As��t/�S � Individual (only for 1QTreasurer � Deputy Treasurer �Candidate ❑ Chairperson (on►y for PC, PTY & electioneering commun.) electioneering commun. organization) X X Sign re S ature DS-DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1} Name J L�'Q0�`�. � ,Ac�,-k�S (2) I.D_ Number (3) Cover Period / I 5 / 7 a through q/�g /(�. (4 Page l of 1 (5) (7) (8) (9) (10) (11) (12) Date Full Name (6) (Last, Suffix, First, Middle) � Sequence Street Address 8 Contributor ConVibution tn-kind Number Ci , State, Zi Code T e Occu ation T e Descri tion Amendment Amount / / � � R c,��,�.� ocr 3 , � � ��Y c � .� ��rr� �� / I / / / / / / / ! DS-DE 13 (Rev. 08103} SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAlGN TREASURER'S REPORT — iTEMIZED EXPENDITURES (1) Name SEf�/�E �kl�,Dr��.S (2) l.D. Number (3) Cover Period q / � � / I :2 through �/ � / 1 � (4) Page � of (5� ��) i8) �9) �10) (11) Date Fuil Name Purposs �s� (Last, Suffix, First, Middle) (add office sought if Street Address 8� contribution to a �penditure Sequence City, State, Zip Code candidate) TYPe Amendment Amount Number RE EIV,�a Z Ci� af '�e�a� CitY CIQ � t,�. ; S Of,��. DS-DE 14 (Rev. 08/03) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES �� HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian. org September 25, 2012 Jerome Adams 901 Roseland Road Sebastian, FL 32958 Dear Mr. Adams: In accordance with Florida Statutes Section 106.07, the G2 campaign treasurer's report for your campaign for the period September 15, 2012 through Friday, September 28, 2012 is due by 5 pm on Friday, October 5, 2012. All contributions and expenditures for that period must be reported. You have from Monday, October 1St through Friday, October 5th to hand deliver your report, however, Florida law allows you to mail the report as long as it is postmarked before midnight of the due date (October 5, 2012) and you include a USPS issued mailing receipt with the report. I encourage you to hand deliver the report in case there is any information missing. If I receive a mailed report and the report is incomplete, according to the State, it is deemed not timely filed and subject to penalty. (2)(a)1.A1/ reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m. of the day designated; however, any report oostmarked by the United States Postal Service no later than midnight of the day desiqnated shall be deemed to have been filed in a timely manner. Any report received bv the filing officer within 5 days after the designated due date that was delivered by the United States Postal Service shall be deemed timely filed unless it has a postmark that indicates that the report was mailed after the desianated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailina, or a receipt from an established courier company, which bears a date on or before the date on which the report is due, shall be proof of mailina in a timely manner Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. The Sebastian River Area Chamber of Commerce and the Sebastian Property Owners Association have decided to combine their efforts to present the October 23rd Candidate Forum in the City Council Chambers with live broadcasts and have canceled the October 25tn event. You will be contacted by them directly. I will be out of the office during the reporting week, except for Wednesday, October 3ra however, you can bring the report on any day and my staff will scan and email the report to me for review before it is stamped in and your stamped copy will then be emailed to you. If you have any questions, please do not hesitate to contact me at 388-8214 or smaioCc�cityofsebastian.org. Sinc rely, Sally A. aio, City Clerk � MMC �� c FLORIDA DEPARTMENT OF STATE DIVISION OF ELECTIONS CAMPAIGN TREASURER'S REPORT SUMMARY �� 7�� OFFICE USE ONLY Name R��'�/�b c2� �c�� C�s��,rn�, R� Address (number and street) C�� % �/,f� �ar� !�� 0'�.S ��.�i'1� �c. 3 2. Ll 5 2i City �� , City, State, Zip Code ❑ CHECK IF ADDRESS HAS CHANGED (3) ID Number: (4) Check appropriate box(es): [vJ�Candidate (office sought): ��2-�aS�� G � � u n "� 1 ❑ Political Committee ❑ CHECK IF PC HAS DISBANDED ❑ Committee of Continuous Existence ❑ CHECK IF CCE HAS DISBANDED ❑ Party Executive Committee ❑ Electioneering Communication ❑ CHECK IF NO OTHER ELECTIONEERING COMMUNICATION REPORTS WILL BE FILED � (5) REPORT IDENTIFIERS CoverPeriod: From g I 2� ! 2�(2- To �/ 1� /,�jZ ReportType �1 [�Original ❑ Amendment ❑ Special Election Report ❑ Independent Expenditure Report (6) CONTRIBUTIONS THIS REPORT (7) EXPENDITURES THIS REPORT Monetary Cash & Checks $ �� Expenditures $ � � Loans � � Transfers to Office Account $ � Total Monetary � � Total Monetary $ (� f (n-Kind � � (8) Other Distributions $ (� (9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date $ 1 ao $ G � (11) CERTIFICATION It is a first degree misdemeanor for any person to falsify a public record (ss. 839.13, F.S.) I certify that I have examined'this report and it is true, I certify that I have examined this report and it is true, correct, and complete. correct, and complete. (Type name) , �� 7-t� (Type name) J ERd (`� L"— f��,� /�S � Individual (oniy tor Treasurer ❑ Deputy Treasurer �Candidate ❑ Chairperson (only for PC, PTY & electioneering commun.) electioneering commun. organization) X "� r'?2>� l� - � �� Signa u Sign re DS-DE 12 (Rev. 08104) CAMPAIGN TREASURER'S REPORT - ITEMIZED CONTRIBUTIONS (1) Name ��Nl� ��S (2) I.D. Number (3) Cover Period � / 23 / ��- through �/ t� / �� (4) Page ` of � c5) i�) c$) c9) i� o) c� �) c� 2) Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address R Contributor Contribution In-kind Number Ci , State, Zi Code T e Occu ation T e Descri tion Amendment Amount $ i '2°� � l� Jer°me ��+r►S � Comp•.��y ��0 ��I �5�1.n� R-�� '7�cln , CI�E po 1 Seb3s��,r, j�. 3z°C�' � � � �� ;t I 1 1 �,'i�,'Y p�� 1 / / / / / / / / / D5-DE 13 (Rev. 08103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES (1) Name ��Qs> NL� �(�.M 5 (2) I.D. Number (3) Cover Period $ / 23 / i2 through �i / �� / � �- (4) Page � of (5) �7) ($) �9) ��) �») Date Full Name Purpose �6� (Last, Suffix, First, Middle) (add office sought if Sequence Street Address & contribution to a Expenditure Number City, State, Zip Code candidate) TYPe Amendment Amount � 2� ( 2 l�'� � JY SLI�S�i>..,.� �P �� G`u..A'l cc` ( . i� a 1 S��S��,�I,rc_ 3zq53 Q;,�.c��;rt� Ft� N��►� .�6 1 ��/�� #y � ��1, �� DS-UE 14 (Rev. OS103) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES �� '�� HOME OF PELICAN ISLAND 1225 Main Street Sebastian, Florida 32958 (772) 388-8214 phone - (772) 589-5570 fax smaio@cityofsebastian. org September 10, 2012 Jerome Adams 901 Roseland Road Sebastian, FL 32958 Dear Mr. Adams: In accordance with Florida Statutes Section 106.07, the G1 campaign treasurer's report for your campaign for the period August 29, 2012 (the day you qualified) through Friday, September 14, 2012 is due by 5 pm on Friday, September 21, 2012. All contributions and expenditures for that period must be reported. Remember that the funds used to open your account are contributions, and your filing fee is an expenditure and both should appear in your G1 report. City Hall is closed for furlough day on Friday, September 21St. During evenings, furloughs, weekends and holidays when City Hall is closed, all entry doors lock automatically, so I will not be here to receive the report on that day. You have from Monday, September 17t" through Thursday, September 20t" to hand deliver your report, however, Florida law allows you to mail the report as long as it is postmarked up to midnight of the due date (September 21St) and you include a USPS issued mailing receipt with the report. I encourage you to hand deliver the report in case there is any information missing. If I receive a mailed report and the report is incomplete, according to the State, it is deemed not timely filed and subject to penalty. (2)(a)Z.AII reports required of a candidate by this section shall be filed with the officer before whom the candidate is required by law to qualify. All candidates who file with the Department of State shall file their reports pursuant to s. 106.0705. Except as provided in s. 106.0705, reports shall be filed not later than 5 p.m, of the day designated; however, any report postmarked by the United States Postal Service no later than midnipht of the day designated shall be deemed to have been filed in a timely manner. Any re�ort received bX the filinq officer within 5 days after the designated due date that was delivered by the United States Postal Service shall be deemed time� filed unless it has a postmark that indicates that the report was mailed after the designated due date. A certificate of mailing obtained from and dated by the United States Postal Service at the time of mailing, or a receipt from an established courier company, which bears a date on or before the date on which the report is due� shall be proof of mailinq in a timely manner. Reports shall contain information of all previously unreported contributions received and expenditures made as of the preceding Friday, except that the report filed on the Friday immediately preceding the election shall contain information of all previously unreported contributions received and expenditures made as of the day preceding that designated due date. All such reports shall be open to public inspection. This same situation may occur in October as well for your G3 report and a furlough day but I'll send another reminder at that time. The Sebastian River Area Chamber of Commerce and the Sebastian Property Owners Association plan to conduct candidate forums in October in the City Council Chambers with five broadcasts --- Chamber 10/23/12 and SPOA 10/25/12 both from 7-9 pm. You will be contacted by them directly. If you have any questions, please do not hesitate to contact me at 388-8214 or smaio(a�cityofsebastian.org. Sincerely, � \ � /,.. .;I _. Sally A. M"aio, City Clerk ��\`� -�� MMC APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. 1. CHECK APPROPRIATE BOX(ES): � Initial Filing of Forrn Re-filing to Change: ❑ 2. Name of Candidate (in this order: First, Middle, Last) �� 1�GN` � M I �l-tl� ��. /�� MS 4. Telephone 5. E-mail address ��7� ) �-�-�-o6c52. /�D/�Ms--�2��4ZT• i�►ET 6. Office sought (include district, circuit, group number) RECEIV�'D ,�� zo�z City o# Sebastian City Clerk's O�c OFFICE USE ONLY Treasurer/Deputy ❑ Depository ❑ Offce ❑ Party 3. Address (include post office box or street, city, state, zip code) � p � 2o sc-�l �n� lZ� � �bc�.ss�•�,�►, FL 3 z� 5� 7. If a candidate for a nonpartisan office, check if applicable: C i-�� (��n L� � J"1.�,y� b�.,� I � My intent is to run as a Write-In candidate. 8. If a candidate for a ap rtisan office, check block and fill in name of party as applicable: My intent is to run as a � Write-In � No Party Affiliation � Party candidate. 9. I have appointed the following person to act as my � Campaign Treasurer � Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer j � RO M � /-��/41�15 11. Mailing Address 12. Telephone �,� 1 iZ:� 5�� v�.� 1� • (� 7.Z) 1-�8� --066 2 13. City 14. County 15. State 16. Zip Code 17. E-mail address SQ.� Cl5tl�21'� �%1�Lw1'1 �l�/e"Y �1.� 32-� �JCS� �i7�c/K,S'Iz� � L 7' /�/�: ( 18. I have designated the following bank as my � Primary Depository 19. Name of Bank 20. Address t�N � 9q3 21. City 22. County 23. State S�� s�� , ��-n.� ia�r� '��ve�r � L-- [� Secondary Depository S�I�a��.`��► 3 I�� 24. Zip Code 3 z� � i� UNDER PENALTIES OF PERJURY, 1 DECLARE THAT 1 HAVE READ 7HE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE. 25. Date 26. Signature of Candidate �`��// �� - I X ,�� i�:�� 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, J�R(�/� � i�7��N� S , do hereby accept the appointment (Please Print or Type Name) designated above as: [� Campaign Treasurer � Deputy Treasurer. g�,�/rz Date nc_nG o �wpu �nwn► 11 ignature of Gampaign � reasurer or vepury i reasurer Rule 9S-2.0001, F.A.C. Name No. 001001 208001 001501 322900 001501341920 001501 341910 001501 341930 601010 343800 001501 343805 CITY OF SEBASTIRN CITY CLERK�S oFF��E . 4 4 8�� RECEIPT _ ❑ Cash - heck # / > �A , �$�?� � . `"�� ount Paid Sales Tax Garage Sales Copiesl8id Specs. LDCICode of Ordinances �� Election Qualifying fees � �� Cemetery Lots LoUNiche , Block , Unit Cem ry Fees � � �5�� ^ _-- - 3 �; -1�u�►� �r�� -=-0- i � ` Total Paid � ' �V In ials White - Dept. of Origin • Yellow - finance • Pink - Applicant �� -�,,,.. � ,. � - -�_ . HOME OF PEUCAN ISLAND ELIGIBILITY TO HOLD OFFICE OF COUNCILMEMBER Charter Section 2.02 - ELIGIBILITY �UG Z 9 2012 City of S�bastian City Clerk's Oit��o "No person shall be eligible to hold the office of counci! member unless he or she is a qualified elector* in said city and actuaUy continually resided in said city for a period of one (1) year immediately preceding the final date for qualification as a candidate for said office." I, �E��/'�1,� %c�Dl�NLS , candidate for the office of Council Member, meet the eligibility qualifications to hold office as required in Section 2.02 of the City of Sebastian Charter, above. �� /�'��Y� S ature of Candidate � j subscribed before me this ��" day of �� , Sworn 2012. Notary Publi State of FI:�F SEAL - ,, � ;�::�� ei%� : SALLY A. MAI O ;.; :.: Commission # EE U24350 :;• o�; Expires October 5, 2014 %� oF F;,.° 8onded Thru Troy Fain Insurance 80�-385-7019 *166.032 Electors.--Arry person who is a resident of a municipality, who has gualified as an elector ojthis state, and who registers in the manner prescribed by general law and ordinance of the municipaliry shall be a qualified elector of the munieipality. Ms-word/eleetion/charter eligibiliry STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) ��M� candidate for the office of /�-M S � t i y �ur��.� � have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X _ Signature of Candidate ��2_((��/ 2 Date Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS-DE 84 (OS/11) CANDIDATE OATH - NONPARTISAN OFFICE (Not for use by Judicial or School Board Candidates) OATH OF CANDIDATE (Section 99.021, Florida Statutes) RECEIV�� u� � � �o�z City of Sebastia � City Clerk's O�Ce �FFICE USE ONLY I, J�iZo M� /�i7 IkN� s (PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT *-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING) am a candidate for the nonpartisan office of L< < Y C�UNCI L/L(,E/`�13 ��. , �office) (district #) � ; I am a qualified elector of �-�-n� i�r1 ��V e�'' County, Florida; (circuit #) (group or seat #) I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the State of Florida. � Signature of Candidate r� ( �� 1�g�—U6 6 � Telephone Number ��'��, F � c�ry scate f�v�Ms-12@�47i�Nc i Email Address 3zR�� ZIP Code Candidate's Florida Voter Registration Number (located on yourvoter information card): IQ 2 0�6�-1� q� " Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with disabilities (see instructions on page 2 of this form): J E l� � �uM � JkN -�J�MS STATE OF FLO IDA � _ COUNTY OF �� v� Sworn to (or affirmed) and subscribed before me this C�� day Personally Known: ✓ or Produced Identification: Type of IdentifiCation Produced: Signature of I Print, Type, or 20%a— >c- • r f� Public Commissioned Name of Notary Public SALLY A, MAIO Commission # Ec 014350 - a �; ;;,�•' ewnaea i nru Tmy Fain Insmanca 800-385-7019 DS-DE 25 (Rev. 5/11) . 01, F.A.C. FOR1V� 1 STATEMENT �F 2011 Please print ortype your name, mailing FINANCIAL INTERESTS address, agency name, and position below: LAST NAME — FIRST NAME — MIDDLE NAME : /�D�/�S � ERoM� H1 t�i�l�� MAILING ADDRESS : �I� � ��SE V�� 1.� CITY : ZIP : COUNTY : S��s�� i�n/ 3�q�� r�� t��.v�r� NAME OF AGENCY : � Z l y �� S L�3�5 1�-/�N NAME OF OFFICE OR POSITION HELD OR SOUGHT : �7..T y Ct.�c�NG�- L /y �l h3 � (-Z You are not Ifmited to the space on the Iines on thfs form. Attach additfonal sheets, if necessary. CHECK ONLY IF �CANDIDATE OR � NEW EMPLOYEE OR APPOINTEE USE ONLY:E ��V��pa �., w ID Cod��ty O f ' �z City Cle k�s p��e ID No. e(`� . �� w`- Conf. Code "� P. Req. Code *'`** BOTH PARTS OF THIS SECTION MUST BE COMPLETED *"** DISCLOSURE PERIOD: THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR YEAR OR ON A FISCAL Y AR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER (must check one): DECEMBER 31, 2011 Q$ ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: THE LEGISLATURE ALLOWS FILERS THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, 1NHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions for further details). PLEASE STATE BELOW WHETHER THIS STATEMENT REFLECTS EITHER (must check one}: LJ COMPARATIVE (PERCENTAGE) THRESHOLDS OR 0a DOLIAR VALUE THRI PART A— PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person - See instructions p. 4] (If you have nothing to report, you must write "none" or "n!a") NAME OF SOURCE OFINCOME „S l. µ7Gt 2 i rQ i YI t`�.Z SOURCE'S ADDRESS DESCRIPTION OF THE SOURCE'S PRINCIPAL BUSINESS ACTIVITY PART B— SECONDARY SOURCES OF INCOME [Major customers, clients, and other sources of income to businesses owned by the reporting person - See instructions p. 4] (If you have nothing to report , you must write "none" or "n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE N//� PAR7 C— REAL PROPERTY [Land, buildings owned by the reporting person - See instructions p: 4] (If you have nothing to report, you must write "none" or "n/a") PRINCIPAL BUSINESS ACTIVITY OF SOURCE FILING INSTRUCTIONS for when and where to file this form are located at the bottom of page 2. INSTRUCTIONS on who must file this form and how to fitl it out begin on page 3. OTHER FORMS you may need to file are described on page 6. CE FORM 1- EBective: January t, 2012. Refe� to Rule 34-8.202(1), F.A.C. (COf1Y11lUBfI OIl fCV@tSB SId6) PAGE 1 PART D— INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - See instructions p. 5j (If you have nothing to report, you must write "none" or "n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES r�� C�.e. :�� i t. 1�l� G 3q,�1� PART E— LIABIUTIES [Major debts - See instructions p. SJ (If you have nothing to report, you must write "none" or "n/a"� NAME OF CREDITOR ADDRESS OF CREDITOR Cl1c�,S-2 3/-�I � �i Si: �'1 %r: (�i�s�✓t�� ' �N� �321 PART F— INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See instructions p. 5] �tf you have nothing to report, you must write "none" or "nJa") BUSINESS ENTITY # 1 BUSINESS ENTITY # 2 BUSINESS ENTITY # 3 NAME OF BUSINESS ENTITY !r/ �-- �j/ � ADQRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY POSITION MELD WITH ENTITY I OWN MORE THAN A 5% INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST IF ANY OF PARTS A THROUGH F ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑ SIGNATURE �required� DATE SIGNED (requiredl: ��e� 1'-�� z�/i 2 FILING INSTRUCTIONS: WHAT TO FILE: WHERE TO FILE: WHEN TO FILE: After completing all parts of this form, ►ncludina If you were mailed the form by the Commission Inifially, each local officer/employee, state siqning�nd dating ft send back only the first on Ethics or a County Supervisor of Elections for o�cer, and specified state employee must sheet (pages 1 and 2) for filing. your annual disGosure filing, return the form to file within 30 days of the date of his or her that location. appointment or of the beginning of employment. If you have nothtng to report in a particular AppointeeswhomustbeconfirmedbytheSenate Local officers/employees file with the Supenrisor section, you must write "none" or "n/a" in that must file prior to confirmation, even if that is less of Elections ofthe county inwhichthey permanently section(s). reside. (If you do not permanently reside in than 30 days from the date of their appointment. Fiorida, file with the Supervisor of the county Cand)dates for publicly-elected local office must where your agency has its headquarters.) file at the same time they file their qualifying NOTE: Siate o�cers or specified sfate employees Papers. MULTIPLE FILING UNNECESSARY: file with ihe Commission on Ethics. P.O. Drawer Thereafter, local o�cers/employees, state Generally, a person who has filed Form 1 for a �5709, Tallahassee, FL 32317-5709; physical o�cers, and specified state employees are calendar or fiscal year is not required to file a address: 36D0 Maclay Boulevard, South, Suite requiredtofilebyJuly1stfollowingeachcalendar second Form 7 for the same year. However, a 201, Tallahassee, FL 32312. year in which they hold their positions. candidate who previously filed Form 1 because of another pubiic position must at least file a copy of Candidates fle this form together with their Finally, at the end of o�ce or employment, his or her original Form 1 when qualifying. qualifying papers. each local offcer/employee, state o�cer, and To determine what category your position falls specified state employee is required to file a under, see the "Who Must File" Instructions on final disclosure form (Form 1 F) within 60 days page 3. of leaving office or empioyment. However, filing a CE Form 1 F(Final Statement of Financial Interests) does p91 relieve the filer of filing a Facsimiles will not be accepted. CE Form 1 if he or she was in their position on December 31, 2011. CE FORM 1- EifacUve' January �. 2012. Retet to Rule 34-8202 (�), F.A.C. PAGE Z