HomeMy WebLinkAboutkjackson_cocc_campaign_treasurers_reports_202109CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
SEPT O3 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
✓ Candidate Office Sought: City Council
❑ 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 08 / 13 / 21 To 08 / 27 / 21 Report Type: 2021 GI
✓ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 100 . 00
Loans $ __, __, __.__
Total Monetary $ __, __, 100.00
In-Kind $ __, __, __.__
(7) Expenditures This Report
Monetary
Expenditures $ __, __, 39 . 00
Transfers to
Office Account $ __, __, __.__
Total Monetary $ __, __, 39 . 00
(8) Other Distributions
$ __, __, __.__
(9) TOTAL Monetary Contributions To Date
$ __, __, 100 . 00
(10) TOTAL Monetary Expenditures To Date
$ __, __, 39 . 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) Kay Jackson
Individual (only for IE X Treasurer ❑ Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X - Candidate ❑ Chairperson (only for PC and PTY)
X- Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 3 / 21 through 08 / 27 / 21 (4) Page 1 of 1
(5)
Date
08/ 13/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Jackson, Kay L
PO Box 1029
Cape Canaveral, FL
32920
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
CHE
(10)
In -kind
Description
N
(11)
Amendment
(12)
Amount
39.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 /13 / 21 through 08 / 27 / 21 (4) Page 1 + of 1
(5)
Date
08/ 13/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
City of Cape Canaveral
100 Polk Avenue
Cape Canaveral, FL 32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Qualifying Fee
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
39.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
SEP 17 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X Candidate Office Sought: City Council
❑ 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 08 / 28 / 21 To 09 / 10 / 21 Report Type: 2021 G1
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 100.00
Loans $ __, __, __.__
Total Monetary $ __, __, __.__
In-Kind $ __, __, __.__
(7) Expenditures
Monetary
Expenditures $ __, __, 00.00
Transfers to
Office Account $ __, __, __.__
Total Monetary $ __, __, __.__
(8) Other Distributions
$ __, __, __.__
(9) TOTAL Monetary Contributions To Date
$ __, __,100 .00
(10) TOTAL
Monetary Expenditures To Date
$ __, __, __.__
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer ❑ Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X- Candidate ❑ Chairperson (only for PC and PTY)
X Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 28 / 21 through 09 / 10 / 21
(4) Page 1 of 1
(5)
Date
09/ 06/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Linda A Hagen
732 Bayside Dr
Unit 303
Cape Canaveral, FL
32920
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIBED
SEP 28 2021
By: KS 12:19 PM
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box (es):
X Candidate Office Sought: City Council
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual Communications Org.
❑ Check here if PC or ECO has disbanded
❑ Check here if PTY has disbanded
❑ Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From 09/ 11/ 21 To 09/ 24 / 21 Report Type: 2021 G1
❑ Original X- Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 650.00
Loans $ __, __, __. __
Total Monetary $ __, __, __.__
In -Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, __. __
Transfers
Office Account $ __, __, __. __
(8)
Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, 850.00
(10)
TOTAL Monetary Expenditures To Date
$ __, __, 0 . 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) Kay Jackson
❑ Individual (only for IE X- Treasurer 0 Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X- Candidate • Chairperson (only for PC and PTY)
X- Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21 (4) Page 1 of 1
(5)
Date
09/ 13/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Eric Holland
157 Anchorage Ave
Apt 4
Cape Canaveral, FL 32920
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
09/ 19/ 21
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
City, State, Zip Code
Mary & Kevin DeMayo
5737 Aspen Green Ct.
Delray Beach, FL 33484-2581
(8)
Contributor
Type
CHE
(8)
Occupation
Tech services/Ins
Wealth Management
(9)
Contribution
Type
Individual
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$50.00
(5)
Date
09/ 21/ 21
(6)
Sequence Number
3
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Katrina A Freeman
504 Fillmore Ave
Apt A5
Cape Canaveral, FL 32920-3145
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$500.00
3
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(9)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
//
//
//
//
//
//
//
//
DS-DE 13A (Rev. 11113)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(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
/
/
/
/
/
/
/
/
/
/
/
/
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
SEPT 28 2021
By: KS 12:19 PM
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X- Candidate Office Sought: City Council
❑ 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 09 / 25 / 21 To 10 / 01 / 21 Report Type: 2021 G1
X- Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 500.00
Loans $ __, __, __. __
Total Monetary $ __, __, __. __
In-Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, 282.10
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 282.10
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, 1350.00
(10) TOTAL Monetary Expenditures To Date
$ __, __, 282.10
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer 0 Deputy Treasurer
or electioneering comm.)
X- Kay Jackson
Signature
(Type name) Kay Jackson
X- Candidate • Chairperson (only for PC and PTY)
X- Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 09 / 25 / 21 through 10 / 01 / 21 (4) Page 1 of 1
(5)
Date
09/ 26/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Michael & Carolyn Storey
4370 Stillwater Drive
Merritt Island, FL 32952-6320
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$500.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 25 / 21 through 10 / 01 / 21 (4) Page 1 of 1
(5)
Date
09/ 25/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Jason Hook Photography
1807 LaPlata Ct
Rockledge, FL 32955
(8)
Purpose
(add office sought if
contribution to a
candidate)
Candidate Photo
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$250.00
(5)
Date
09 / 28 / 21
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
City of Cape Canaveral
Fridayfest fee
100 Polk Ave
Cape Canaveral, FL 32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Fridayfest Vendor Fee
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$32.10
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 09 / 25 / 21 through 10 / 01 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 08 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
✓ Candidate Office Sought: City Council
❑ 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 / 02 / 21 To 10 / 08 / 21 Report Type: 2021 G1
X- Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __,10 . 00
Loans $ __, __, 27.82
Total Monetary $ __, __, 00.00
In-Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __. 472 . 73
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 472. 73
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, 1387. 82
(10) TOTAL Monetary Expenditures To Date
$ __, __, 754 . 83
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer 0 Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X- Candidate ❑ Chairperson (only for PC and PTY)
X- Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10/ 02 / 21 through 10/ 08/ 21
(4) Page 1 of 1
(5)
Date
10/ 04/ 2021 +
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Morteza Amirkhani
3245 Sparling
Cummings, GA 30041
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
(10)
In -kind
Description
N
(11)
Amendment
(12)
Amount
10.00
___ ___
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 10 / 02 / 21 through 10 / 08 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10/ 02 / 21 through 10 / 08 / 21
(4) Page 1 + of 1
(5)
Date
10/ 04/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Southern Tape and Label
1107 Peachtree Street
Cocoa, Florida 32922
(8)
Purpose
(add office sought if
contribution to a
candidate)
Signage
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
444.91
(5)
Date
09/ 30/ 2021,
(6)
Sequence Number
2
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Dollar Tree
7201 Shoppes Drive
Melbourne, FL 32940
(8)
Purpose
(add office sought if
contribution to a
candidate)
Trunk or Treat
decor and
FridayFest decor
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
27.82
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
Cover Period 10 / 02 / 2 + through 10 / 08/ 21
(4) Page 1 of 1
(5)
Date
10/ 04/ 21 +
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Southern Tape and
Label
1107 Peachtree Street
Cocoa, Florida 32922
(8)
Purpose
(add office sought if
contribution to a
candidate)
Signage
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
444.91
(12)
Distribution
Type
PPD
(5)
Date
09 /30 / 2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Dollar Tree
7201 Shoppes Drive
Melbourne, FL 32940
(8)
Purpose
(add office sought if
contribution to a
candidate)
Trunk or Treat
decor and
FridayFest decor
(9)
Related Expenditures
(10)
Amendment
(11)
Amount
27.82
(12)
Distribution
Type
CCP
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER®S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 15 2021
By: KS 1:46 PM
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box (es):
X- Candidate Office Sought:
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO) 0 Check here if PC or ECO has disbanded
❑ Party Executive Committee (PTY) 0 Check here if PTY has disbanded
❑ Independent
individual Expenditure (IE) (also covers an ❑ Check here if no other IE or EC reports will be filed
making electioneering communications)
(5) Report Identifiers
Cover Period: From 10/ 09/ 2021 To 10/ 15/ 2021 Report Type: 2021 G1
❑ Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 110.00
Loans $ __, __, __. __
Total Monetary $ __, __, __. __
In -Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, 499.86
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 499.86
This Report
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, 1497.82
(10) TOTAL Monetary Expenditures To Date
$ __, __, 1254 . 69
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer 0 Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X- Candidate 0 Chairperson (only for PC and PTY)
X Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 10 / 09 / 2021 through 10 / 15 / 2021 (4) Page 1 of 1
(5)
Date
10/ 12/ 2021
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Richard & Brigette Ardolino
2775 Ridge Street
Yorktown Heights, NY 10598
(8)
Contributor
Type
I
(8)
Occupation
Retired
(9)
Contribution
Type
CAS
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 01 /2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
City, State, Zip Code
Morteza Amirkhani
3245 Sparling
Cummings, GA 30041
(8)
Contributor
Type
I
(8)
Occupation
Francisee
(9)
Contribution
Type
CAS
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$10.00
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 09 / 2021through 10 /15 / 2021
(4) Page 1 of 1
(5)
Date
10/13/2021
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Address N' Mail Inc.
2212 Sarno Road
Melbourne, FL 32935
(8)
Purpose
(add office sought if
contribution to a
candidate)
Mailer
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$499.86
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I.D, Number
(3) Cover Period 10 / 09 / 2021 through 10 / 15 / 2021
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
(12)
Distribution
Type
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 22 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X- Candidate Office Sought: City Council
❑ Political Committee (PC)
❑ Electioneering Communications Org. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering communications)
❑ Check here if PC or ECO has disbanded
❑ Check here if PTY has disbanded
❑ Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From 08 / 28 / 21 To 09 / 10 / 21 Report Type: 2021 G2
❑ Original X- Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 100.00
Loans $ __, __, __.__
Total Monetary $ __, __, __.__
In -Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures
$ __, __, 00.00
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 00.00
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, $100 . 00
(10) TOTAL Monetary Expenditures To Date
$ __, __, __. __
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer 0 Deputy Treasurer
or electioneering comm.)
X
Signature
(Type name) Kay Jackson
X- Candidate 0 Chairperson (only for PC and PTY)
X
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name
Kay Jackson
(2) I.D. Number
(3) Cover Period 08 / 28 / 21 through 09 / 10 /21
(4) Page 1 of 1
(5)
Date
09/06/21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Linda A Hagen
732 Bayside Dr
Unit 303
Cape Canaveral, FL
32920
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
09/ 14 /21
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Go Daddy
2150 E. Werner Road
Tempe, AZ 85284-3401
(8)
Purpose
(add office sought if
contribution to a
candidate)
City Council
(9)
Expenditure
Type
Website,
Domain,
& Hosting
(10)
Amendment
(11)
Amount
$125.88
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 22 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X- Candidate Office Sought: City Council
❑ 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 09 / 11 / 21 To 09 / 24 / 21 Report Type: 2021 G3
❑ Original X- Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 650.00
Loans $ __, __, __. __
Total Monetary $ __, __, __. __
In-Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, __. __
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, __. __
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, 850.00
(10) TOTAL Monetary Expenditures To Date
$ __, __, 0.00
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer ❑ Deputy Treasurer
or electioneering comm.)
X
Signature
(Type name) Kay Jackson
X- Candidate ❑ Chairperson (only for PC and PTY)
X
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
09/ 13/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Eric Holland
157 Anchorage Ave
Apt 4
Cape Canaveral, FL 32920
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
09/ 19/ 21
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Mary & Kevin DeMayo
5737 Aspen Green Ct.
Delray Beach, FL 33484-2581
(8)
Contributor
Type
CHE
(8)
Occupation
Tech Services/Ins
Wealth Management
(9)
Contribution
Type
Individual
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$50.00
(5)
Date
09/ 21/ 21
(6)
Sequence Number
3
(7)
Full Name
(Last, Suffix, Frist, Middle)
Street Address &
City, State, Zip Code
Katrina A Freeman
504 Fillmore Ave
Apt A5
Cape Canaveral, FL 32920-3145
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$500.00
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(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
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I. D. Number
(3) Cover Period 09 / 11 / 21 through 09 / 24 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought it
contribution to a
candidate)
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
(12)
Distribution
Type
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 22 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X- Candidate Office Sought: City Council
❑ 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 09 / 25 / 21 To 10 / 01 / 21 Report Type: 2021 G4
❑ Original X- Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 500.00
Loans $ __, __, __. __
Total Monetary $ __, __, __. __
In-Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, 282.10
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 282 .10
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ , __, __ 1350 . 00
(10) TOTAL Monetary Expenditures To Date
$ __, __, 282.10
(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) Kay Jackson
❑ Individual (only for IE X- Treasurer ❑ Deputy Treasurer
or electioneering comm.)
X
Signature
(Type name) Kay Jackson
X-Candidate • Chairperson (only for PC and PTY)
X
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 09 / 25 / 21 through 10 / 01 / 21 (4) Page 1 of 1
(5)
Date
09/ 26/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Michael & Carolyn Storey
4370 Stillwater Drive
Merritt Island, FL 32952-6320
(8)
Contributor
Type
CHE
(8)
Occupation
(9)
Contribution
Type
Individual
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$500.00
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 25 / 21 through 10 / 01 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(9)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 09 / 25 / 21 through 10 / 01 / 21 (4) Page 1 of 1
(5)
Date
09/ 25/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Jason Hook Photography
1807 LaPlata Ct.
Rockledge, FL. 32955
(8)
Purpose
(add office sought if
contribution to a
candidate)
Candidate Photo
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$250.00
(5)
Date
09 l 28 / 21
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
City of Cape Canaveral
Fridayfest fee
100 Polk Ave
Cape Canaveral, FL 32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Fridayfest Vendor Fee
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$32.10
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
Cover Period
09 / 25 / 21 through 10 / 01 / 21 (4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
(12)
Distribution
Type
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 22 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
✓ Candidate Office Sought: City Council
❑ 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 / 02 / 21 To 10 / 08 / 21 Report Type: 2021 G5
❑ Original X-Amendment ❑ Special Election Report
(6) Contributions This Report \
Cash & Checks $ __, __, 10.00
Loans $ __, __, 27.82
Total Monetary $ __, __, 00.00
In-Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, 472.73
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 472.73
(8) Other Distributions
$ __, __, __. ___
(9) TOTAL Monetary Contributions To Date
$ __, __, 1387. 82
(10) TOTAL Monetary Expenditures To Date
$ __, __, 754.83
(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) Kay Jackson
❑ Individual (only for IE X-Treasurer 0 Deputy Treasurer
or electioneering comm.)
X
Signature
(Type name) Kay Jackson
X- Candidate 0 Chairperson (only for PC and PTY)
X
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10/ 02/ 21 through 10/ 08/ 21
(4) Page 1 of 1
(5)
Date
10/ 04/ 2021
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Morteza Amirkhani
3245 Sparling
Cummings, GA 30041
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
(10)
In -kind
Description
N
(11)
Amendment
(12)
Amount
444.91
(5)
Date
09/30/ 2021
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Contributor
Type
(8)
Occupation
(9)
Contribution
Type
(10)
In- Kind Description
(11) Amendment
(12)
Amount
27.82
/
/
/
/
/
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 02 / 21 through 10 / 08 / 21
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 02 / 2 + through 10 / 08 / 21
(4) Page 1 of 1
(5)
Date
10/ 04/ 21
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Southern Tape and Label
1107 Peachtree Street
Cocoa, Florida 32922
(8)
Purpose
(add office sought if
contribution to a
candidate)
Signage
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
444.91
(5)
Date
09 / 30/ 2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Dollar Tree
7201 Shoppes Drive
Melbourne, FL 32940
(8)
Purpose
(add office sought if
contribution to a
candidate)
Trunk or Treat
decor and
FridayFest decor
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
27.82
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10/ 02/ 2 + through 10/ 08/ 21
(4) Page 1 of 1
(5)
Date
10/ 04/ 21 +
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Southern Tape and
Label
1107 Peachtree Street
Cocoa, Florida 32922
(8)
Purpose
(add office sought if
contribution to a
candidate)
Signage
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
444.91
(12)
Distribution
Type
PPD
(5)
Date
09 30 2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Dollar Tree
7201 Shoppes Drive
Melbourne, FL 32940
(8)
Purpose
(add office sought if
contribution to a
candidate)
Trunk or Treat
decor and
FridayFest decor
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
27.82
(12)
Distribution
Type
CCP
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
OCT 22 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X- Candidate Office Sought:
❑ 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 / 09 / 2021 To 10 / 15 / 2021 Report Type: 2021 G6
❑ Original X- Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 110.00
Loan $ __, __, __. __
Total Monetary $ __, __, __. __
In-Kind $ __, __, __. __
(7) .Expenditures This Report
Monetary
Expenditures $ __, __, 499.86
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, 499.86
(8) Other Distributions
$ __, __, __. __
(9) TOTAL Monetary Contributions To Date
$ __, __, 1497.82
(10) TOTAL Monetary Expenditures To pate
$ __, __, 1254 . 69
(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) Kay Jackson
❑ Individual (only for IE X-Treasurer ■ Deputy Treasurer
or electioneering comm.)
X
Signature
(Type name) Kay Jackson
X-Candidate • Chairperson (only for PC and PTY)
X
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson
(2) I.D. Number
(3) Cover Period 10 / 09 /2021 through 10 / 15 / 2021 (4) Page 1 of 1
(5)
Date
10/ 12/ 2021
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Richard & Brigette Ardolino
2575 Ridge Street
Yorkstown Heights, NY 10598
(8)
Contributor
Type
I
(8)
Occupation
Retired
(9)
Contribution
Type
CAS
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 01 /2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Morteza Amirkhani
3245 Sparling
Cummings, GA 30041
(8)
Contributor
Type
I
(8)
Occupation
Francisee
(9)
Contribution
Type
CAS
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$10.00
/
/
/
/
/
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 09/ 2021 through 10 / 15 / 2021
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 09 / 2021 through 10 15 / 2021 (4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
(12)
Distribution
Type
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 09 / 2021 through 10 /15 / 2021
(4) Page 1 of 1
(5)
Date
10/ 13 /2021
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Address N' Mail Inc
2212 Sarno Road
Melbourne, FL 32935
(8)
Purpose
(add office sought if
contribution to a
candidate)
Mailer
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$499.86
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street)
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
NOV 01 2021
By: CCO DL
❑ Check here if address has changed (3) ID Number
(4) Check appropriate box(es):
X- Candidate Office Sought: City Council
❑ Political Committee (PC)
❑ Electioneering Communicators Org. (ECO)
❑ Party Executive Committee (PTY)
❑ Independent Expenditure (IE) (also covers an
individual making electioneering commucations)
❑ Check here if PC or ECO has disbanded
❑ Check here if PTY has disbanded
❑ Check here if no other IE or EC reports will be filed
(5) Report Identifiers
Cover Period: From 10 / 16 / 2021 To 10 / 28 / 2021 Report Type: 2021 G7
X- Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __, __, 300.00
Loans $ __, __, 320.00
Total Monetary $ __, __, __.__
In -Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, __, 249.48
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, __, __. __
(8)
Other Distributions
$ __, __, __. __
(9) TOTAL
Monetary Contributions To Date
$ , __, __, 2117.82
(10)
TOTAL Monetary Expenditures To Date
$ __, __, 1504.17
(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) Kay Jackson
0 Individual (only for IE X-Treasurer 0 Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X - Candidate ❑ Chairperson (only for PC and PTY)
X Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 16 / 2021 through 10 / 22 / 2021
(4) Page 1 of 1
(5)
Date
10/ 22/ 2021
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Jeff & Kristi Denton
1375 Hannah Circle
Merritt Island, FL 32953
(8)
Contributor
Type
I
(8)
Occupation
Logistics/
BCPS
(9)
Contribution
Type
CHE
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 28 / 2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Bob & Michelle Billings
236 Fox Run
Venetia, PA 15367
(8)
Contributor
Type
I
(8)
Occupation
Retired
(9)
Contribution
Type
CHE
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 18 2021
(6)
Sequence Number
3
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Kay Jackson
PO Box 1029
Cape Canaveral, FL 32920
(8)
Contributor
Type
S
(8)
Occupation
Property &
Rental
Management
Services
(9)
Contribution
Type
LOA
(10)
In-Kind Description
Loan too Campaign
to cover cost of
mailer #1
(11)
Amendment
(12)
Amount
$60.00
(5)
Date
10 / 28 / 2021
(6)
Sequence Number
4
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Bio States Medical
16014 E. Lehigh Circle
Aurora, CO 80013
(8)
Contributor
Type
B
(8)
Occupation
Bio Medical
Services
(9)
Contribution
Type
CHE
(10)
In-Kind Description
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 27 2021
(6)
Sequence Number
5
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Kay Jackson
PO Box 1029
Cape Canaveral, FL 32920
(8)
Contributor
Type
I
(8)
Occupation
Property &
Rental
Management
Services
(9)
Contribution
Type
LOA
(10)
In-Kind Description
Loan to Campaign
to cover cost of
mailer #2
(11)
Amendment
(12)
Amount
$260.00
/ /
/ /
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 16 / 2021 through 10 / 28 / 2021
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 16 / 2021 through 10 / 28 / 2021
(4) Page 1 of 1
(5)
Date
10/ 27/ 2021
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Address N' Mail Inc
2212 Sarno Road
Melbourne, FL 32935
(8)
Purpose
(add office sought if
contribution to a
candidate)
Mailer
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
249.48
//
//
//
//
//
//
//
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED DISTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 16 / 2021 through 10 / 28 / 2021 (4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
(8)
Purpose
(add office sought if
contribution to a
candidate)
(9)
Related
Expenditures
(10)
Amendment
(11)
Amount
(12)
Distribution
Type
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
DS-DE 14A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CITY OF CAPE CANAVERAL
100 POLK AVE.
CAPE CANAVERAL, FL 32920
(321) 868-1220
Received Of: KAY JACKSON
The sum of: $150.00
RECEIPT
11/01/2021 16:08
Number: 69307
Cashier: j.coldiron
MISC
MISC
Total
$150.00
$150.00
Remaining; Balance: $0 00
TENDERED: CHECK
1060
$150.00
CITY OF
CAPE CANAVERAL
PO. Box 326 • 100 Polk Avenue • Cape Canaveral, FL 32920-0326
(321) 868-1220 www.cityofcapecanaveral.org
November 1, 2021
Kay Jackson
P.O. Box 1029
Cape Canaveral, FL 32920
VIA CERTIFIED MAIL (7015 0640 0004 1076 4809), STANDARD MAIL and EMAIL
Re: 2021 Campaign Treasurer's Report 2021 G7, Due October 29, 2021
Dear Ms. Jackson,
On Monday, November 1, 2021, the City Clerk's Office received, via hand -delivery, your Campaign
Treasurer's Report, 2021 G7, covering activity from October 16, 2021 to October 28, 2021. The due
date for this report was Friday, October 29, 2021.
Per Section 106.07(8)(b), Florida Statutes, a fine of $50.00 per day for the first 3 days late and,
thereafter, $500.00 per day for each late day, not to exceed 25 percent of the total receipts or
expenditures, whichever is greater, for the period covered by the late report, must be paid to the
filing officer (me) within 20 days after receipt of the Notice of Payment Due.
In accordance with Florida Statute, you are hereby assessed a fine of $150. This letter serves to
confirm the fact you paid this fine via funds from a personal account at the same time that you
submitted your report.
If you have any questions regarding this letter, please do not hesitate to contact our office at
321-868-1220 x207/x206 or via e-mail at CityClerk@CityofCapeCanaveral.org.
Sincerely,
Mia Goforth, CMC
City Clerk/Elections Qualifying Officer
Cc: Todd Morley, City Manager
John DeLeo, Administrative/Financial Services Director
Anthony Garganese, City Attorney
U.S. Postal ServiceTM
CERTIFIED MAIL RECEIPT
Domestic Mail Only
For delivery information, visit our website at www.usps.com
OFFICIAL USE
Certified Mail Fee
$
Extra Services & Fees (check box, add fee as appropriate)
0 Return Receipt (hardcopy) $_______
0 Return Receipt (electronic) $ _______
0 Certified Mail Restricted Delivery $ _____
0 Adult Signature Required $ _____
0 Adult Signature Restricted Delivery $ _____
Postage
$
Total Postage and Fees
$
Sent to
Jackson
Street and Apt. NO., or PO Box No.
PO BOX 1029
City, State, Zip + 4
CC Fl 32920
PS Form 3800, April 2015 PSN 7530-02-000-9047
See Reverse for Instructions
7015 0640 0004 1076 4809
CAPE CANAVERAL
NOV 01 2021
USPS-FL-32920
Postmark Here
SENDER: COMPLETE THIS SECTION
0 Complete items 1, 2, and-3.
• Print your name and address on the reverse
so that we can return the card to you. 0 Attach Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Kay Jackson
P.O. Box 1029
CC FL 32920
IIIII IIIIIII IIIIIII IIIII IIIIII IIIIII
9590 9402 6268 0274 5001 23
COMPLETE THIS SECTION ON DELIVERY
A. Signature
X Kay Jackson
B. Received by (Printed Name)
0 Agent
0 Addressee
C. Date of Delivery
11-12-21
D. Is delivery address different from item 1? 0 Yes
if YES, enter delivey address below: 0 No
2. Article Number LTransfer from service label) ,
1).1illRt j
701 5 "0640 0004 C]716 4809
PS Form 3811. July 2020 PSN 7530-02-000-9053
3. Service Type
❑ Adult Signature
❑ Adult Signature Restricted Delivery
Certified Mall®
❑ Certified Mall Restricted Delivery
Collect on Delivery
O Collect on Delivery Restricted Delivery
011osured vlail II
❑ Insured Mall Restricted Delivery
(over $500)
❑ Priority Mail Express®
❑ Registered MailTM
❑ Registered Mail Restricts
Delivery
❑ Signature ConfirmationTM
❑ Signature Confirrnation
l Restricted Delivery
Domestic Return Receipt
USPS TRACKING #
ORLANDO FL 328
12 NOV 2021 PM 2L
9590 9402 6268 0274 5001 23
United States
Postal Service
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4® in this box
CITY OF CAPE CANAVERAL
City Clerk's Office
P. O. Box 326
Cape Canaveral, FL 32920-0326
0-032626 IIIIIII IIIIIIIIIII IIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIII
CAMPAIGN TREASURER'S REPORT SUMMARY
(1) Kay Jackson
Name
(2) PO Box 1029
Address (number and street))
Cape Canaveral, FL 32920
City, State, Zip Code
OFFICE USE ONLY
RECEIVED
JAN 31 2022
CCO DL
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
X- Candidate Office Sought: City Council
❑ 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 X- Check here if no other IE or EC reports will be filed
individual making electioneering communications)
(5) Report Identifiers
Cover Period: From 08 / 13 / 21 To 10 / 28 / 2021 Report Type: 2021TR
X- Original ❑ Amendment ❑ Special Election Report
(6) Contributions This Report
Cash & Checks $ __,1, 770.00
Loans $ __, __, 359.00
Total Monetary $ __, 2, 129.00
In-Kind $ __, __, __. __
(7) Expenditures This Report
Monetary
Expenditures $ __, 1,129.00
Transfers to
Office Account $ __, __, __. __
Total Monetary $ __, 2 ,129.00
(8) Other Distributions
$ __, __, __.__
(9) TOTAL Monetary Contributions To Date
$ , 2 , 129 . 00
(10) TOTAL Monetary Expenditures To Date
$ __, 2 ,129 .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) Kay Jackson
❑ Individual (only for IE X- Treasurer • Deputy Treasurer
or electioneering comm.)
X Kay Jackson
Signature
(Type name) Kay Jackson
X- Candidate 11 Chairperson (only for PC and PTY)
X- Kay Jackson
Signature
DS-DE 12 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 13 / 2021 through 01 / 30 / 2022 (4) Page 1 of 3
(5)
Date
08/ 13 / 2021
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Jackson, Kay L
PO Box 1029
Cape Canaveral, FL
32920
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
LOA
(10)
In -kind
Description
N
(11)
Amendment
(12)
Amount
$39.00
(5)
Date
09 / 06 / 2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Linda A. Hagen
732 Bayside Dr
Unit 303
Cape Canaveral, FL 32920
(8)
Contributor
Type
I
(8)
Occupation
(9)
Contribution
Type
CHE
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
09 / 13 / 21
(6)
Sequence Number
3
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Eric Holland
157 Anchorage Ave
Apt 4
Cape Canaveral, FL
32920
(8)
Contributor
Type
I
(8)
Occupation
(9)
Contribution
Type
CHE
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
09 / 19 / 2021
(6)
Sequence Number
4
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Mary & Kevin DeMayo
5737 Aspen Green Ct.
Delray Beach, FL 33484-2581
(8)
Contributor
Type
I
(8)
Occupation
(9)
Contribution
Type
CHE
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$50.00
(5)
Date
09 / 21 / 2021
(6)
Sequence Number
5
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Katrina A Freeman
504 Fillmore Ave
Apt 5
Cape Canaveral, FL 32920
(8)
Contributor
Type
I
(8)
Occupation
(9)
Contribution
Type
CHE
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$500.00
(5)
Date
09 / 26 / 2021
(6)
Sequence Number
6
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Michael & Carolyn Storey
4370 Stillwater Drive
Merritt Island, FL 32952
(8)
Contributor
Type
I
(8)
Occupation
(9)
Contribution
Type
CHE
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$500.00
(5)
Date
10 / 01 / 2021
(6)
Sequence Number
7
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Morteza Amirkhani
3245 Sparling
Cummings, GA 30041
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
RCT
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$10.00
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 13 / 2021 through 01 / 30 / 2022 (4) Page 2 of 3
(5)
Date
10/ 04/ 2021
(6)
Sequence Number
8
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Morteza Amirkhani
3245 Sparling
Cummings, GA 30041
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
RCT
(10)
In -kind
Description
N
(11)
Amendment
(12)
Amount
$10.00
(5)
Date
10 / 12 / 2021
(6)
Sequence Number
9
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Richard & Brigette Ardolino
2575 Ridge Street
Yorktown Heights, NY 10598
(8)
Contributor
Type
I
(8)
Occupation
Retired
(9)
Contribution
Type
RCT
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 18 / 2021
(6)
Sequence Number
10
(7)
Full Name
(Last, Suffix, First, Middle)
City, State, Zip Code
Kay Jackson
PO Box 1029
Cape Canaveral, FL
32920
(8)
Contributor
Type
I
(8)
Occupation
Self
(9)
Contribution
Type
LOA
(10)
In-Kind Description
Loan to Campaign
to cover cost of
Mailer #1
(11)
Amendment
(12)
Amount
$60.00
(5)
Date
10/ 22 / 2021
(6)
Sequence Number
11
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Jeff & Kristi Denton
1375 Hannah Circle
Merritt Island, FL 32953
(8)
Contributor
Type
I
(8)
Occupation
Logistics/
BCPS
(9)
Contribution
Type
RCT
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 27 / 2021
(6)
Sequence Number
12
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Kay Jackson
PO Box 1029
Cape Canaveral, FL
32920
(8)
Contributor
Type
S
(8)
Occupation
Self
(9)
Contribution
Type
LOA
(10)
In-Kind Description
Loan to Campaign
to cover cost of
Mailer #2
(11)
Amendment
(12)
Amount
$260.00
(5)
Date
10 / 28/ 2021
(6)
Sequence Number
13
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Bio States Medical
16014 E. Lehigh Circle
Aurora, CO 80013
(8)
Contributor
Type
B
(8)
Occupation
Bio Medical
Services
(9)
Contribution
Type
RCT
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$100.00
(5)
Date
10 / 28 / 2021
(6)
Sequence Number
14
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Bob & Michelle Billings
236 Fox Run
Venetia, PA 15367
(8)
Contributor
Type
I
(8)
Occupation
Retired
(9)
Contribution
Type
RCT
(10)
In-Kind Description
N
(11)
Amendment
(12)
Amount
$100.00
DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED CONTRIBUTIONS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 13 / 2021 through 01 / 30 / 2022 (4) Page 3 of 3
(5)
Date
10/ 30/ 2021
(6)
Sequence Number
15
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Sarah Hodge
390 Sanders Lane
Merritt Island, FL
32953
(8)
Contributor
Type
I
(8)
Retired
Occupation
(9)
Contribution
Type
RCT
(10)
In -kind
Description
(11)
Amendment
(12)
Amount
$100.00
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DS-DE 13 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - FUND TRANSFERS
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 13 / 2021 through 08 / 27 / 2021
(4) Page 1 of 1
(5)
Date
(6)
Sequence Number
(7)
Name of Financial
Institution
Street Address &
City, State, Zip Code
(8)
Transfer
Type
(9)
Nature of
Account
(10)
Amendment
(11)
Amount
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DS-DE 13A (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT - ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 08 / 13 / 2021 through 10 / 30 / 2022
(4) Page 1 of 3
(5)
Date
08/ 13/ 2021
(6)
Sequence Number
1
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
City of Cape Canaveral
100 Polk Avenue
Cape Canaveral, FL 32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Qualifying Fee
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$39.00
(5)
Date
09 / 14 /2021
(6)
Sequence Number
2
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Go Daddy
2150 E. Werner Road
Tempe, AZ 85284-3401
(8)
Purpose
(add office sought if
contribution to a
candidate)
Website, Domain, &
Hosting
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$114.18
(5)
Date
09 / 25 /2021
(6)
Sequence Number
3
(7)
Full Name
(Last, Suffix, First, Middle)
City, State, Zip Code
Jason Hook Photography
1807 LaPlata Ct.
Rockledge, FL 32955
(8)
Purpose
(add office sought if
contribution to a
candidate)
Candidate Photo
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$250.00
(5)
Date
09 /28 /2021
(6)
Sequence Number
4
(7)
Full Name
(Last, Suffix, First, Middle)
City, State, Zip Code
City of Cape Canaveral
100 Polk Ave
Cape Canaveral, FL 32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Friday fest Vendor Fee
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$32.10
(5)
Date
10 / 04 / 2021
(6)
Sequence Number
5
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Southern Tape and Label
1107 Peachtree Street
Cocoa, FL 32922
(8)
Purpose
(add office sought if
contribution to a
candidate)
Signage
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$444.91
(5)
Date
09 /30 / 2021
(6)
Sequence Number
6
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Dollar Tree
7201 Shoppes Drive
Melbourne, FL 32940
(8)
Purpose
(add office sought if
contribution to a
candidate)
Trunk or Treat and
Fridayfest
Deco Items
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$27.82
(5)
Date
10 /13 / 2021
(6)
Sequence Number
7
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Address N' Mail Inc.
2212 N. Sarno Road
Melbourne, FL 32935
(8)
Purpose
(add office sought if
contribution to a
candidate)
Mailer
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$499.86
(%0
Date
10/ 27/ 2021
(6)
Sequence Number
8
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Address N' Mail Inc.
2212 N. Sarno Road
Melbourne, FL 32935
(8)
Purpose
(add office sought if
contribution to a
candidate)
Mailer #2
(9)
Expenditure
Type
ECC
(10)
Amendment
(11)
Amount
$250.00
DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES
CAMPAIGN TREASURER'S REPORT — ITEMIZED EXPENDITURES
(1) Name Kay Jackson (2) I.D. Number
(3) Cover Period 10 / 28 / 2021 through 01 / 31 / 2022
(4) Page 2 of 2
(5)
Date
11/ 01/ 2021
(6)
Sequence Number
9
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Florida Beer Company
200 Imperial Blvd
Cape Canaveral, FL 32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Campaign with the
Cape Canaveral Monday
Night Running Club
(9)
Expenditure
CAN
Type
(10)
Amendment
(11)
Amount
$8.88
(5)
Date
11 / 01 / 2021
(6)
Sequence Number
10
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Paypal
2211 N. 1st Street
San Jose, CA 95131
(8)
Purpose
(add office sought if
contribution to a
candidate)
Campaign Donations
via PayPal Service Fees
charged
(9)
Expenditure
Type
CAN
(10)
Amendment
(11)
Amount
$21.58
(5)
Date
01 / 30 /2022
(6)
Sequence Number
11
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Sarah Hodge
390 Sanders Lane
Merritt Island, FL
32953
(8)
Purpose
(add office sought if
contribution to a
candidate)
Refund, donation past
acceptance date
(9)
Expenditure
Type
REF
(10)
Amendment
(11)
Amount
$-100.00
(5)
Date
01/ 30/ 2022
(6)
Sequence Number
12
(7)
Full Name
(Last, Suffix, First, Middle)
Street Address &
City, State, Zip Code
Kay Jackson
PO Box 1029
Cape Canaveral, FL
32920
(8)
Purpose
(add office sought if
contribution to a
candidate)
Loan Repayment
(9)
Expenditure
Type
REF
(10)
Amendment
(11)
Amount
$-340.17
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DS-DE 14 (Rev. 11/13)
SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES