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Gordon, Golene 10-21-24- Amendment to Notice of Intent to Run APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN FILED DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) OCT 21 2024 (PLEASE PRINT OR TYPE) CITY CLERK'S OFFICE NOTE: This form must be on file with the filing officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): ❑■ Initial Filing of Form i Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last): 3. Address (include PO Box or Street, City, State, Zip Code): (Please Print or Type Name) 1500 GATEWAY BLVD. STE 220 GOLENE GORDON BOYNTON BEACH, FL, 33426 4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address: (561 ) 853-5959 109786189 E l e ctG g o rd o n@ G m a i I.C O M (not required for qualifying purposes) 7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a nonpartisan office, check the box Commissioner District 1 if I intend table: ❑ to run as a Write-In Candidate. 9. If a candidate for=bun office, check the box and fill in the name of the party as applicable: I intend to run as a Write-In Candidate. ■ ❑ ❑ No Party Affiliation Candidate. ❑ Party candidate. 10. I have appointed the following person to act as my: CI Campaign Treasurer ❑ Deputy Treasurer 11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address: Golene Golene (561 )853-5959 ELECTGGORDON@GMAIL.COM 14. Mailing Address: 15. City: 16. State: 17. Zip Code: 1500 Gateway Blvd Ste 220 Boynton Beach FL 33426 18. I have designated the following bank as my (check appropriate box): ❑■ Primary Depository ❑ Secondary Depository 19. Name of Bank: 20. Address: Wells Fargo 200 N Congress AVE 21. City: 22. County: 23. State: 24. Zip Code: Boynton Beach Palm Beach FL 33426 UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE. 26. Signature of Candidate: 25. Date: M/2/!? 2/ A? v ( 27. Treasurer' Acceptance of Appointment (fill in the blanks and check the appropriate box) GOLENE GORDON do hereby accept the appointment designated above as: (Please Print or Type Name) ❑■ Campaign Treasurer. ❑ Deputy Treasurer. 29. Signature of Campaign reasurer or Deputy Treasurer 28. Date: /1/4//d--,/ v DS-DE 9 (Rev.09/23) /` Rule 1S-2.0001, F.A.C. OFFICE USE ONLY STATEMENT OF CANDIDATE FILED (Section 106.023, F.S.) OCT 21 2u24 (Please print or type) CITY CLERK'S OFFICE 1, GOLENE GORDON candidate for the office of CITY COMMISIONER DISTRICT 1 ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X ( r lD g/ a Signature of Candidate 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(05/11) - J