HomeMy WebLinkAboutAdams TR Campaign ReportCAMPAIGN TREASURER'S REPORT SUMMARY
(1) Jerome Adams OFFICE USE ONLY
Name RECie, VE
(2) 901 Roseland Rd. p
NOV
Address (number and street) 2 0 20 4
204
Sebastian, FL 32958 City Of
City Clerbastie
ao
City, State, Zip Code ks n
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
❑✓ Candidate office Sought: Councilmember
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) ❑ Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) ❑ Check here if PTY has disbanded
❑ Independent Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 10 / 18/ 14 To 11 / 15 / 14 Report Type: TR
❑� Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
(7) Expenditures This Report
Monetary
Cash & Checks $ 0 0 0 00
Expenditures $ 0 0 12 . 84
Loans $ 0 0 0 00
Transfers to
Office Account $ 0 0 0 .00
Total Monetary $ 0 0 0 00
Total Monetary $ 0 0 12 . 84
In -Kind $ 0 0 0 00
(8) Other Distributions
$ 0 0 0 00
(9) TOTAL Monetary Contributions To Date
(10) TOTAL Monetary Expenditures To Date
S 0 1, 330 00
$ 0 1 330 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, correct, and complete:
(Type name) Jerome Adams (Type name) Jerome Adams
❑ Individual (only for IE I] Treasurer ❑ Deputy Treasurer 171 Candidate ❑ Chairperson (only for PC and PTY)
or electioneering comm)
Sig re SidnAture
DS -DE 12 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT— ITEMIZED EXPENDITURES
(1) Name Jerome Adams
(3) Cover Period 10 / 31 / 14 through 11
(2) I.D. Number
05 / 14 (4) Page 1 of 1
(s)
Date
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Expenditure
Type
(10)
Amendment
(11)
Amount
(6)
Sequence
Number
11 05 14
001
Walgreens
999 Sebastian Blvd
Sebastian, FL 32955
Cards
CAN
$10.68
11 15 14
Jerome Adams
901 Roseland Rd.,
Sebastian, FL 32958
Repay loan
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DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES