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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 DIS ®2.16 ND City?Qf Qty C �y ? t ksbastia ce DS -DE 14 (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES