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Filing Papers Miscellaneous Cash Receipt _ No. 92134 CITY OF BOYNTON BEACH m _ ~TON 6 Account No. 001-0000-369-10-00 $ 25.00 C, 2_;, 20 .. rte. . Received of GOLENE L. GORDON C-s�' f p Address P.O. BOX 4303 BOYNTON BEACH, FL 33424 :�; For CITY FILING FEE TO RUN FOR MAYOR ON MARCH 12, 20 o -71 Dept. CITY CLERK'S OFFICE By Miscellaneous Cash Receipt No. 92133 CITY OF BOYNTON BEACH = — a 0 —P ~TCNg Account No. 001-0000-369-10-00 $ 306.81 C) cC - ,.20 — r Received of GOLENE L. GORDON x} Address P.O. BOX 4303 BOYNTON BEACH, FL 33424 For 1$ FILING FEE TO RUN FOR MAYOR ON MARCH 12, 201 r rn Dept. CITY CLERKS OFFICE By MATERIAL FOR CANDIDATES 111/4, YOU HAVE INDICATED YOUR DESIRE TO BECOME A CANDIDATE; THEREFORE, I HAND YOU THE FOLLOWING: 1. `/ Qualifying Information &Municipal Election Schedule 2. / Dates to Remember 3. ` Form DS-DE 9 Appointment of Campaign Treasurer and Designation of Campaign Depository for Candidates -TO BE SIGNED AND RETURNED TO CITY CLERK INDICATING YOUR INTENT TO RUN. 4. Residency Requirements(To be filled out and returned to City Clerk) 5. Form DS-DE 84 Statement of Candidate&copy of Chapter 106, Florida Statutes(Must be filed with City Clerk within 10 days after filing Appointment of Campaign Treasurer- Intent ) 6. V State of Florida Election Laws-Chapters 99, 105 & 106 7. j Guide to Sunshine Amendment&Code of Ethics for Public Officers and Employees 8. V Directions for Posting Temporary Political Sign 9. City Map and District Maps 10. J Part I Charter, Article VII. Elections-City of Boynton Beach 11. V Part II Code of Ordinances-Chapter 2 Administration, Article III. Elections 12. Poll Watcher Form &FS 101.131-"Watchers at Polls" 13. ". Public Campaign Financing Handbook 14. I/Candidate Petition Handbook 15. (� Blank Campaign Report Summary Sheets, Contributions Sheets& Expenditures Sheets 16. j. Petition Form-Candidate for Commissioner-TO BE FILLED OUT, CERTIFIED BY SUPERVIOSR OF ELECTIONS AND RETURNED TO CITY CLERK DURING QUALIFYING 17. 1J Form 1 Statement of Financial Interests 2014 - TO BE FILLED OUT, SIGNED & RETURNED TO THE CITY CLERK DURING QUALIFYING 18. L&A TESTING NOTICE (SIGN AND RETURN AT TIME OF QUALIFYING.) 19. lit/ Loyalty Oath - Oath of Candidate (DS-DE 24B) - TO BE RETURNED TO CITY CLERK DURING QUALIFYING RECEIVED BY: J /4 // Candidate Signature to Signed .t.ZLifil a :74" Judith' . Pyle,CMC City erk Amor. Updated 07/21/17 S:\CC\WP\ELECTION\Year 2019\MATERIAL FOR CANDIDATES.docx CANDIDATE OATH — NONPARTISAN OFFICE CI of BU'r ri Ula BEACH (CII Y CLERK'S OFFICE (Do not use this form if a Judicial or School Board Candidate) .leck box only if you are seeking to qualify as a 19 JAN _8 PH 12: I I write-in candidate: ❑ Write-in candidate OFFICE USE ONLY Candidate Oath (Section 99.021(1)(a), Florida Statutes) i' I. (iIelle o►'c�'Pnl (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.) am a candidate for the nonpartisan office of ilia j V (/ ,3&�) ') �'� 13tiactl l ( fce) (District#) ,I am a qualified elector of (POJ 13ea 1' ) County, Florida; (Circuit#) (Group or Seat#) 111 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. gc Candidate's Florida Voter Registration Number(located on your voter Information card); /Li I rJ X9 Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities(see instructions on page 2 of this form):(Not applicable to write-in candidates.] C:.7c? L 6g/t/ (ic10E. — AV/1/ (rf 13. Q Z�5 J / IPcia t)rcioAl(kJ C-'itila . (-011 Signature of Candidate Telephone Number Ei►hall Address r7' 1 1 1 /l�ft-?L(/� C( - 34i-67 tC1'l'1 e 3' g2Code Address 6 (/ City 7 STATE OF FLORIDA Signature of Notary Public COUNTY OF Print,Type,or Stamp Commissioned Name of Notary Public below Sworn to(or affirmed)and subscribed before me this Cf6of :PO4(, SHAYLAS.ELLIS day of_ J�;J v L , 20 0.. . * st a}c*MY COMMISSION#GG 031774 N� ''!� -` e EXPIRES:September 19,2020 d� ,. 94-OF pe NNW Thlu 041011 Met4fy BO wl Irsonally Known.:, or Rfedtieed,., stion IType of Identification Produced: DS-DE 302NP(Rev.11/17) Rule 15-2.0001,F.A.C. CI I i tab b`Ut r41 Uig BEACH CANDIDATE OATH — CII Y CLERK'S OFFICE NONPARTISAN OFFICE 19 JAN —8 P,,, 12: 1 I (Not for use by Judicial or School Board Candidates) OFFICE USE ONLY OATH OF CANDIDATE (Section 99.021,Florida Statutes) I, Golene Gordon (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 Mayor of Boynton Beach (office) (district#) ; I am a qualified elector of Palm Beach 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. X ciL (561 ) 853-5959 electggordon@gmail.com Signature of Candidate Telephone Number Email Address 230 Lake Monterey Cir Boynton Beach FL 33426 Address City State ZIP Code Candidate's Florida Voter Registration Number(located on your voter information card): 109786189 * 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): GO - LEEN b/2 STATE OF FLORIDA tllfl0l / COUNTY OF V V o13 JO Sworn to(or affirmed)and gu ¢Yib�4r bore k this ' day of C_P(1\o-2i , 20 lyj . • 1.06 le DO oN OZOZ'6l Jagwaldag sandx3.wwoo )4. Personally Known: or▪4_:• • n7` Signature of ublic Produced Identification: // ‘S ,`, Print,Type,oommissioned Name of Notary Public 00 Type of Identification Produced: rYi c C I I CC 1 _I C l DS-DE 25(Rev.5/11) Rule 1S-2.0001,F.A.C. FORM 1 STATEMENT OF 2018 Please print or type your name,mailing FINANCIAL INTERESTS FOR OFFICE USE ONLY: address,agency name,and position below: LAST NAME--FIRST NAME--MIDDLE NAME: —^• r")-7 Gordon, Golene MAILING ADDRESS : 230 Lake Monterey Cir. rnc -'. CITY: ZIP: COUNTY: Boynton Beach 33426 Palm Beach = Iv r cr, NAME OF AGENCY: rri rnn NAME OF OFFICE OR POSITION HELD OR SOUGHT: Mayor of Boynton Beach You are not limited to the space on the lines on this form.Attach additional sheets,if necessary. CHECK ONLY IF [l' CANDIDATE OR LI NEW EMPLOYEE OR APPOINTEE **** 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 YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING EITHER(must check one): 0D DECEMBER 31, 2018 OR U SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR: MANNER OF CALCULATING REPORTABLE INTERESTS: FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES,WHICH REQUIRES FEWER CALCULATIONS, OR USING COMPARATIVE THRESHOLDS,WHICH ARE USUALLY BASED ON PERCENTAGE VALUES(see instructions for further details). CHECK THE ONE YOU ARE USING(must check one): ❑ COMPARATIVE(PERCENTAGE)THRESHOLDS OR U DOLLAR VALUE THRESHOLDS PART A--PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY Ocean East Properties 640 East Ocean Ave. Boynton Beach, - Real Estate Florida 33435 PART B-- SECONDARY SOURCES OF INCOME [Major customers,clients,and other sources of income to businesses owned by the reporting person-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS BUSINESS ENTITY OF BUSINESS'INCOME OF SOURCE ACTIVITY OF SOURCE PART C--REAL PROPERTY [Land,buildings owned by the reporting person-See instructions] FILING INSTRUCTIONS for when (If you have nothing to report,write"none"or"n/a") and where to file this form are located at the bottom of page 2. 230 Lake Monterey Cir. Boynton Beach, FL 33426 INSTRUCTIONS on who must file this form and how to fill it out begin on page 3. CE FORM 1-Effective-January 1,2019 (Continued on reverse side) PAGE 1 Incorporated by reference in Rule 34-8.202(1).FA.C. PART D—INTANGIBLE PERSONAL PROPERTY[Stocks,bonds,certificates of deposit,etc.-See instructions] (If you have nothing to report,write"none"or"n/a") TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES 401K Wells Fargo Mutual Fund USAA PART E—LIABILITIES [Major debts-See instructions] (If you have nothing to report,write"none"or"n/a") NAME OF CREDITOR ADDRESS OF CREDITOR Chase Mortgage P.O. Box 9001871 Louisville, KY 40290-1871 Navient P.O. Box 740351, Atlanta, GA 30374-0351 PART F—INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses-See instructions] (If you have nothing to report,write"none or"n/a") BUSINESS ENTITY#1 BUSINESS ENTITY#2 NAME OF BUSINESS ENTITY ADDRESS OF BUSINESS ENTITY PRINCIPAL BUSINESS ACTIVITY "\\4, POSITION HELD WITH ENTITY r I OWN MORE THAN A 5%INTEREST IN THE BUSINESS NATURE OF MY OWNERSHIP INTEREST PART G—TRAINING For elected municipal officers required to complete annual ethics training pursuant to section 112.3142,F.S. ❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING. IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE j SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY If a certified public accountant licensed under Chapter 473,or attorney Signature: in good standing with the Florida Bar prepared this form for you,he or ss) she must complete the following statement: L I , prepared the CE Form 1 in accordance with Section 112.3145, Florida Statutes, and the instructions to the form.Upon my reasonable knowledge and belief,the disclosure herein is true and correct. Date Signed: CPA/Attorney Signature: �v l Date Signed: FILING INSTRUCTIONS: If you were mailed the form by the Commission on Ethics or a County Candidates file this form together with their filing papers. Supervisor of Elections for your annual disclosure filing, return the MULTIPLE FILING UNNECESSARY:A candidate who files a Form form to that location. To determine what category your position falls 1 with a qualifying officer is not required to file with the Commission under, see page 3 of instructions. or Supervisor of Elections. Local officers/employees file with the Supervisor of Elections WHEN TO FILE: Initially, each local officer/employee, state officer, of the county in which they permanently reside. (If you do not and specified state employee must file within 30 days of the permanently reside in Florida, file with the Supervisor of the county date of his or her appointment or of the beginning of employment. where your agency has its headquarters.) Form 1 filers who file with Appointees who must be confirmed by the Senate must file prior to the Supervisor of Elections may file by mail or email. Contact your confirmation, even if that is less than 30 days from the date of their Supervisor of Elections for the mailing address or email address to appointment. use. Do not email your form to the Commission on Ethics, it will be Candidates must file at the same time they file their qualifying returned. State officers or specified state employees who file with the papers. Commission on Ethics may file by mail or email. To file by mail, Thereafter, file by July 1 following each calendar year in which they send the completed form to P.O. Drawer 15709, Tallahassee, FL hold their positions. 32317-5709; physical address: 325 John Knox Rd, Bldg E, Ste 200, Finally, file a final disclosure form (Form 1F) within 60 days of Tallahassee, FL 32303. To file with the Commission by email, scan leaving office or employment. Filing a CE Form 1F(Final Statement your completed form and any attachments as a pdf(do not use any of Financial Interests)does not relieve the filer of filing a CE Form 1 other format) and send it to CEForm1©leg.state.fl.us. Do not file by if the filer was in his or her position on December 31,2018. both mail and email. Choose only one filing method. Form 6s will not be accepted via email. PAGE 2 CE FORM 1-Effective:January 1,2019. Incorporated by reference in Rule 34-8.202(1),F.A.C. yP fir 9 Palm Beach County OF pP 240 SOUTH MILITARY TRAIL WEST PALM BEACH, FL 33415 POST OFFICE BOX 22309 WEST PALM BEACH, FL 33416 SUSAN BUCHER Supervisor of Elections TELEPHONE: (561 ) 656-8200 FAX NUMBER: (561 ) 656-6287 WEBSITE: www.pbcelections.org CERTIFICATION I, SUSAN BUCHER, SUPERVISOR OF ELECTIONS, for Palm Beach County, Florida, do hereby certify that 26 signatures on the Nominating Petitions of GOLENE GORDON for MAYOR FOR THE CITY OF BOYTON BEACH are registered electors within the municipal limits of the CITY of BOYNTON BEACH, according to the registration records on file in this office. This is to further certify that GOLENE GORDON is a registered voter in Precinct 4053, in the City of Boynton Beach, Florida. Signed, this the 21th day of December, 2018. i3 21.1-00(in SUSAN BUCHER co 73-` SUPERVISOR OF ELECTIONS v't.. PALM BEACH COUNTY (V -nal C7� (SEAL) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for . 6_..e... ..a-- (---'l Qt.— it the undersigned, a registered voter � p P name as it appears on your voter information card) ^ / /�✓/�C 60i-070'v in said state and count etition to have the name of ( [ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] el Nonpartisan / �'� p ❑No party affiliation ❑ �/ Party candidate for the office of a p✓ P� ' eat (insert tle of office End inclu district, circuit,group, seat number, if applicable) pp ) Date of Birth or Voter Regist6ration Number Address (MM/DD/YY) r, V l U a- /7) tt gay bie City County State Zip Code/ Botirm3i°acpateio beach coin PL 339'L 0 Signature of Voter ' r Date Signed (MM/DD/YY) .'� [to be comp) ed by ote ' C.C.__ IO /g /X Rule 1S•2.045,F.A.C. DS-DE 104(Eff.09/11) POSTULACION DE CANDIDATO Notas: -Toda la informacion contenida en este formulario se convertiro en registro publico una vez recibido por el SupervisJ d elecciones. -Firmar más de una postulacion para un candidato a sabiendas constituye un delito. ISeccion 104.185, Estatutos de Florida] -Si no se completa toda la informacion solicitada, este formulario carece de validez pare la Postulacion de candidatos. EI/La que suscribe, C,.6 ) Nmo-t v\ votante registrado/a (nombre en letra de imprenta tal como figura en su tarjeta de inf ma'ciio de votante) en el mencionado estado y condado,solicito que se incluya el nombre de V e e—tJP en la papeleta de eleccion primaria/general como:[marcar/completar casilla segtin corresponda] itNo partidista ©Sin filiaciOn partidaria © ---- "/ Candidato con filiaciOn partidaria para el cargo de illaqc»7 --- i9iiiii6f)9 ' ea.c1 (insertar titufio del cargo incluir distritot,circuito,grupo,numero de escano,si corresponde) Fecha de nacimiento`0 N'registrorededevotante Direction A � � M c)(� (MM/DD/AA) L ` V� Ya \ . Ciudad Condado Estado Codig�al r ani beach Reath teeil P:k- (''.`J Firma •• votante Fecha firma(MM/DD/AA) ,,iCs,.. ,a/C0177 pl tar por vo ante] INorma 1S-2.045,F.A.C. Departamento de Estado,Division de Elecciones DS-DE 104(Vie.09/11) CANDIDATE PETITION / Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for . o f 0/! \..{�( t , io ,`tf the undersigned, a registered voter (print name as it appears on your voter information card) • in said state and county, petition to have the name of (;6C/drii 661d4"/ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation (_- ----❑ �— I — �_Party candidate for the office of Pp1)r 17 - '� �7 &h2Ch (insert titl of office and it 1 de district,circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address - (MM/DD/YY), 19110 11 if3, 115 W140- d-6 d- Luk-Q- Or) L C r2 Ci CounVy CoState 1 Zip Code Z \0 Dil A"fir ....11 e ; , o math f- 33(/-2_,I . Signature Date Signed (MM/DD/YY) [to be 7m let d by Vot R e 1S-2.045,F. . DS-DE 104(Eff.09111) POSTULACION DE CANDIDATO � _Notas: -Toda la informacion contenida en este formulario se convertiro en registro publico una vez recibido por el Sur rvisor de elecciones. ��// -Firmar más de una postulacion para un candidate a sabiendas constituye un delito. [Seccion 104.185, Estatuto e lorid -Si nose completa' toda la informacion solicitada, este formulario carece de validez para la Postulacion de candidatos. El/La que suscribe, Ui ( votante registrado/a (nombre en letra de imprenta I como figura en su tarjeta de informacion de votante) �} en el mencionado estado y condado,solicito que se incluya el nombre de G ii P V V C- Cor l0t`l en la papeleta de eleccion primaria/general como:[marcar/completarcasilla segtin corresponda] No partidista Sin filiation partidaria Candidato con filiacion partidaria para el cargo de il alftOY fl}� bQaLI? (in ertar ulo del carg e incluir distri o,circuito,grupo,ntimero de escano,si corresponde) Fecha de M/ nacimie(nto 0 N°registro de votante Dirección {� ,�n' (MDD/AA) C tof?;1)?;1) /�1 tailOAPI V 3c IS G .0 Ciudad Condado Estado Codigo postal boOtio bw.i) 9clo [Mach (1,114/11 ial, 3-3 .t,2_,C0 F m de votante Fecha firma(MM/DD/AA) e- [a completar por votante] ,). 1 Catid 1,242X) IIB INorma 1S-2.045,F.A.C. Departamento de Estado,Division de Elecciones DS-DE 104(Vig.09/11) • (,> CANDIDATE PETITION IR,---7 Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested//;r informationonthis form is not completed, the form will not be valid as a Candidate Petition form. /� v ,\1 lf ' `i til the undersigned, a registered voter (c�i Ucf(print name as it a•pears on your voter in : ation card) //'' in said state and county, petition to have the name of ( � dertc C ort o' V placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] I[$1Nonpartisan ❑No party affiliation ❑ Party candidate for the office of et q DY or - -30 0-107 '--- -Ca_C3--) 1112 ((insert title f office and i dude district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address -62 /YY) /34 SE 9y. City County State Zip Code ZONitY) 2 eac,h Raitit '400(0-7 co p462L Vis Signature of Voter Date Signed (MM/DD/YY) "IF /..,09" �/ 409; //// [ C_.. [to be m le e b Voter] iiie Rule 1 -2.045,F.A.C. DS-DE 104(Eff.09111) 0 CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 04-0m \ isSCjI\ the undersigned, a registered voter (print name as it appearsrson your voter information card) in said state and county, petition to have the name of ciaeneC� 17, AJ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ \ Party candidate for the office of lypy acv-i-r/v 73& t L-j(insert title f office ane district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address W11°016115 f),\AlgvikIL fismvm>4' City Coun State Zip Code bl)V7iPPY) pecto, CVLin 339 Signature of V•,er Date Signed (MM/DD/YY) J" [to pe 7,Ietgd/ oterj Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09/11) 4 CANDIDATE PETITION I Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. l the undersigned, a registered voter (print name as it appears on your vot-"r information card) Gordo /�in said state and county, petition to have the name of 0 e placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation E Party candidate for the office of /I/ 0 eat y (insert ti of o ice an inc ude district, circuit,group, seat number, if applicable) t Date of Birth or Voter Registration Number Address (MM/DD/YY) � °7 (?q( 9-301-12'go- /�ioir 6-1 Ci.z City County State Zip Code )bfitI1 '?,_6(d0 ?di/ el POth alli, ir,,Z, 3 3 e./2 & Signatur- • •t-/ Date Signed (MM/DD/YY) [to be comple d by V ter] Rule 1S- '45,F.• . / DS-DE 104(Eff.09/11) ( CANDIDATE PETITION 44e:7 Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections.-It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 'VtrJ J _i eei to Ii✓tt, bxx.Vtd the undersigned, a registered voter (print name as it appears on your voter information card) / /1/ &oydowin said state and county, petition to have the name of •v1 evV e placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ Party candidate for the office of (insert11 title of ffice and incl�lde district, circuit,group, seat number, if applicable) it* eYotCh PP ) Date of Birth or Voter Registration Number Address (MM/DDNY) IDS Nein lake tg goifildim Beach ad_ 33‘,44:. f, I-1-1183 la-,S p 6.61b City County State Zip Code Ppiidlr). /Ma) Tech kid') (.014/717 r--4 33 42-6, Signature of Voter Date Signed(MM/DD/YY) � [to be completed by Voter] & ' , to / -'- , 3 -d-o lq Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09/11) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. G f 4 n l `, the undersigned, a registered voter nt ame as it appears on your voter information card) in said state and county, petition to have the name of ci O%?" t/ GO72 /V' placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] JNonpartisan ❑No party affiliation CD candidate for the office of n col ot ?)0 'Z &ILI/7 � tl �(insert title office and inclue district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) ! oS1 gc f fariVek) ZAP-- IHAr City County State Zip Code b01040 I 6t, Jm c e tJ C1� '/-� 33 �y (o Signature of Vo -r Date Signed(MM/DD/YY) [to be completed by Voter] Pi 1 4/ Rule 1S•2.045,F.A.C. DS-DE 104(Eff.09/11) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. 113e2-It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. -, 5p `(k,CD 6`' ,41 . Gews the undersigned, a registered voter (print name as it appears on your voter information card) n �� Gairdp in said state and county, petition to have the name of (vim` e N placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] �]Nonpartisan ❑No party affiliation ❑ Party candidate for the office of 0 CIOY 101 6** 6t°6Cri (insert ti a of office an include district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address 35g S. SPac sf BLVd (MM/DD/YY) 1 p-29-lg4,n 1 I R930-3C6 3bItY1 "8,eixi,ki /..- 33 V35- Cityexiiricim County State / Zip Code ibtlx� �/i tom7 L 3343,5— Signature 3SSignature of Voter Date Signed (MM/DD/YY) [to be completed by Voter] St/2,L(ti ,t) i• �� e'l/,)4k(1. 12-- - 13 -2-0n5 Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09111) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition forpc(7 \f\Vk(v-e_ P-e_d\ch-p_,Li the undersigned, a registered voter (print name as it appearron your vr information card) in said state and county, petition to have the name of / a ole a C- )orarof l/ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] k.Nonpartisan ❑No party affiliation ❑ Party candidate for the office of IT (inse itle o officellnd include district, circuitgroup, seat number, if applicable) . pP ) Date of Birth //��or Voter Registration Number Addressreh(MM/DD/YY)V d � 7 / `t V b - T3 Q c D r . City County State Zip Code *4/ ( &/C171 Yati;7 teach CVW1 l___ -33112 Signature of Voter ________-- ------, Date Signed (MM/DD/YY) i __ [to be completed by Voter] Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09111) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 1 vt F—( L bo ,\,f t s the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of 0/Phi L$ O1uO/V placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] VNonpartisan ❑No party affiliation ❑ Party candidate for the office of U1ct YOJT ,"eq_Ci'� (insert ti a of office and include district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) / / ii / i q 7 d-,3 d La_\4Q. yo 0-i) kizt4 Cji /e,,, City County State Zip Code By* beau, 'No jec h Coufpi__ 3-3 JZ Signature of Voter Date Signed (MM/DD/YY) [to be co plet by Voter] \) v ms' s if/g /S7 Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09/11) t • CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. SW\E\ the undersigned, a registered voter (print name as appears on your voter information card) in said state and county, petition to have the name of (.`j e I 6)Or do// placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] ;!Nonpartisan ❑No party affiliation ❑ Party candidate for the office of TOtp.7Y 8Olittley? B-earm (insert tle of office aVa include district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DDNY) 3fLAVE City County State Zip Code ayaiN ea-CY.C/47 Wit)/ B 7Arm Signature o o Date Signed (MM/DD/YY) • [to be completed by Voter] 13`/91// Rule 1S• 45,F.A.C. DS-DE 104(Eff.09/11) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If.,1 requested inform.tion on this form is not completed, the form will not be valid as a Candidate Petition form. .4,/atiaill Y CO/ `Q-' 't the undersigned, a registered er • int game as 1 ".pears on your voter informatio card) in said state and co ty petition to the name ofc>o ei Y e b ✓ / placed on the Primary/General Elecif Ballot as a: [check/complete box, as applicable] 77kNonpartisan ❑No party affiliation ❑ Y \ / Party candidate for the office of r})ct 'i G�^ �@oLyJ+trY7 'm ert title of offsa and includerict, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address ( LiK(2I _L()�MMD/Y,Y��I `� f/� /Y/V' ` �( /',� N3 11904 City County State Zi Code 1010r eCh dmic tpu ,�L � 1 `i (0 y Signu of Voter Signed (MM/DD/YY) / [to be compl ted bVoter] (- /?//Y 8 Rule 1S•2.045,F.A.C. DS-DE 104(Eff.09/11) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all,/ t), requested information on this form is not completed, the form will not be valid as a Candidate Petition fo m. o cd C/�jlJig a the undersigned, a registered voter (print name as it appears on your voter information card) -7 in said state and county, petition to have the name of �Y (7)ed/v placed on the Primary/General Election Ballot as a:[check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ Party candidate for the office of 01"- bc" .102 i---)•erch CSL insert title of o ce and includqdistrict, circuit,group,seat number, if applicable) Date of Birth or Voter Registration Number Ad rens (MM/DD/YY) /20 t()sn9Zci &a/00-n (xms CI' r City County State Zip Code tetT/V14/0 P}eq CO T9111 T2eacil Pi- Sign t - of Voter g Date Signed(MM/DD/YY) < [to be co p! to by Voter] Rule 1 .045,F.A.C. DS-DE 104(Eff.09/11) • CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. ,/ -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for j(Y14 fi Q 1 J 2. j J(` the undersigned, a registered voter (print name as it appears'oonyou�oter information card) ,, ( in said state and county, petition to have the name of -4" l/t/ Ge)Y` V placed4on the Primary/General Election Ballot as a: [check/complete box, as applicable) [yJ Nonpartisan ❑No party affiliation ❑ �- - -Party candidate for the office of iI1II(1i & /117'?)'7 & (4 (irt title of ice and include district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address (7Z (90 (SD Dc-ea_fri Oi/Oci City nty State Zip Code *fi 6/ 13 eat 7:4/ th '3 5(i 3 Si at of Voter Date Signed (MM/DDIYY) [to be c p►eted by Voter] AAtek/ l'eC. Rue 15-2.045,F.A.C. DS-DE 104(Eff.09111) CANDIDATE PETITION I Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition fo . ( JUM— the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of £Oen" C) o(070/V placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ /- _.._____-------N__, --- Party candidate for the office of CA -11-1)1411-f0Y) P M y (insert titl of office andclude district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/DD/YY) P i b 0_,W-. City County State Zip Code jfJIiY) P-ctej, Wm )(-bich twinly .G 5 —2C,,D, Si', atu - of , er Date Signed(MM/DD/YY) ►;� ' [to be completed by Voter] lime I '1 Ai 1�9 l�l� ( ,Z5 Rule iS-2.0 •, L. DS-DE 104(Eff.09111) CANDIDATE PETITION I Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested informat'on on this form is lot completed, the f(rm will not be valid as a Candidate Petition form. ( I � p / //� V 1,(� )( f the undersigned, a registered voter (print ame as it-app-ars on your voter information card) in said state and county, petition to have the name of (-50/e/ le aordP/v placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] 7--\Nonpartisan ❑No party affiliation ❑ ..------- Party candidate for the office of /a V174 ' 3D r, c-b (insert title of office d include district, circuit,group, seat number, if applicable) Date of Birth or Voter Re istration Number Address (MM/DD/YY) ) ISS /age Q9/, &e CIS r City County State Zip Code vq 7cCi/? 74 eeach toutP---Z .332- Signature of Voter j �✓I 4 Date Signed (MM/DD/YY) ,/�— [to be co plete by Voter] / / ./ /a' /1 ig Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09/11) t CANDIDATE PETITION itt Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. I -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. G_,iIM aa 1L / 4 ) - the undersigned,a registered voter (print name as it appears on your voter information card) in said state and county,petition to have the name of 60(i9sv?e - eordo/v placed on the Primary/General Election Ballot as a:[check/complete box, as applicable] Nonpartisan ElNo party affiliation El Party candidate for the office of �' & Th1fzeatm (insert tle of office dnd include district,circuit,group,seat number, if applicable) P ) Date of Birth or Voter Registration Number Address (MM/DD/YY) 1//1,2_r /5 '/rig /,5 Zgge' / ,iy j City County State Zip Code P�a-&h ?abil i th Cour 32 y Signature of Voter Date Signed (MM/DD/YY) &‘414ii4.., .../.,a,t [to be completed by Voter] p//1 / 1 Rule Is 2.045,F.A.C. DS-DE 104(Eff.09111) t CANDIDATE PETITION / Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. / -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] «</// -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form i 01 iWtin the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county,petition to have the name of cO/e VL e C o rd 0 y placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] rANonpartisan ❑No party affiliation El )r/77-\/' Party candidate d date for the office of ago/ - •ti3voryirm —6eacl-) 11) (insert title office and inelude district, circuit,group, seat number, if applicable) Date of Birth cora Voter Registration Number Address �p,,e olQ -L ,k-t -tocit7 City County State Zip Code - 0 y04*? 1 eon, 2eat19 tOu4 33`t c. Signature of Voter Date Signed (MM/DD/YY) � [to be co pleted by Voter] l aI I l E Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09/11) CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. / -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. 11/, ///.)j L �' }-} j••/ (/ V� the undersigned, a registered voter (ptlP nam_ea�it a. earnyour information oter information card) /C in said state and county,petition to have the name of G(/`, t' e,orcioiki placed on the Primary/General Election Ballot as a:[check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ Party candidate for the office of Tap l �l17 23eaGh insert itle o ofti and include it district,circuit,group,seat number, if applicable) PP ) - Date of Birth or Voter Registration Number Address q fc e �:o 0 14 7-Le, rex/ (MM/DD/YY) -i - Z (-1- 7Z- ( : r [ ( -e_ City County State Zip Code hif* Bei r � 6e� (Pile pLSigna ure Voter / Date Signed (MM/DD/YY) [to bebe -/completed by Vote .,/,/ A �� v I - '-(/ Rule 1S-2.045,F.A.C. l DS-DE 104(ER.09111) f • CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statute -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition r . 1l , / 1 •7 _ ( [ the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county, petition to have the name of bOlt9,�e 6)04) lik/ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] (�]Nonpartisan ElNo party affiliation ❑ Party candidate for the office of Y1ctn. insert title o office and inclu e dis rict, circuit,group, seat numb r, if applicable) pp ) Date of Birth or Voter Registration Number Address 771 /03r4290'9O 2,,2cr Care ,,, ,4 y oitc/c City County State Zip Code tritiv evtai ?i,476,,,,, pi,/p. 3 eij ,334g. 7 Signature of Voter Date Signed (MM/DD/YY) -` [to be co pleted by Voter] // S'' . Rule IS•2.045, /C. DS-DE 104(Eff.09/11) { \ CANDIDATE PETITION / Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. ✓ -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. ( U )2/Ziiy / I KCl e-2.QA/ 4-E u toi the undersigned, a registered voter (print name as it appears on your voter information card) in said state and county,petition to have the name of G 0 lie V u c 60ida/V placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ Party candidate for the office of niay o 6 � (insert ti a of oice andiclu�strict circuit,group, seat at number , if applicable) Date of Birth or Voter Registration Number Address (5%ii f 07T 1taM3CISic. as 'T ve y i t City Cou ty StateZip Code 0 be-0(0 ? Pa0 cu, a 3 3 Ki. („ , 60 Signature of Voter Date Signed(MM/DD/YY) [to be completed by Voter] . . . w�-_ - 12II6V aoit Rule 1S-2.045,F.A.C. DS-DE 104(Eff.09111) i CANDIDATE PETITION [i Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for . Al ,14-:C;;/6'V C/ the undersigned, a registered voter print name as it appears on your voter information card) /� , p� / in said state and county, petition to have the name of ( D�L ? ���ON10 ) 7 placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation 0 Party candidate for the office of 1Y)ayu ' (insert ti e of o ice a include? P'Ottrict circuit group,g p, seat number, if applicable) Date of Birth or Voter Registration Number Address 0.230 /4, yj j7m � ��� (�� Y) l 116 qgojdo--27.0eii,1�Ff `33 City County State Zip Code yolav ?Ai/ bead') C01/039 � i3 -4 . Signature of VoterDate Signed (MM/DD/YY) / �_ [to be completed by Voter] • Ic: ? Rule 1S-2.045,F.A. DS-DE 104(Eff.09/11) i t \. CANDIDATE PETITION / Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. (/ -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] f-If all requested information on this form is not completed, the form will not be valid as a Candidate Petition for . -, '`'o(, A DJ[esS ,,r�.- the undersigned, a registered voter (print name as it appears on your voter formation card) / /� in said state and county, petition to have the name of v I (/��Y (/✓ placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation 0 (- Party candidate for the office of Ds 7wtmW F9ecifi (insert of ofcend include district, circuit,group, seat number, if applicable) Date of Birth or Voter Registration Number Address (MM/ Nn (nit t 1( dal L-cti32 Yk84,fre,„7--6,,f4 City County State Zip Code 24 00 ow) qato ppo COun P4 ...3 (-/ Signature of Voter Date Signed(MM/DD/YY) a _illt [to be c mpiet d by ter] Rule 1S-2.04 ,F.A.C. DS-DE 104(Eff.09/11) (, • CANDIDATE PETITION Notes: -All information on this form becomes a public record upon receipt by the Supervisor of Elections. -It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes] -If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form. i Lou rl ck ,sose p h the undersigned, a registered voter (print name as it appears on your voter information card in said state and county, petition to have the name of l/yO/e J V e G ordo/V placed on the Primary/General Election Ballot as a: [check/complete box, as applicable] Nonpartisan ❑No party affiliation ❑ _ Party candidate for the office of MCI pr o nC (insert title f office and irfclude district, circuit,group, seat number, if applicable) PP ) Date of Birth or VoteriRegistration Number Address (MM/DD/YY) 118 8 3 ,s51 Zolut /1104reg 7 City County State Zip Code bo &f/ttb ?cdo7 be� 3 3 Li 2 ), y Signature o •ot: Date Signed (MM/DD/YY) [to be comple ed by ter] �I lZIzl$ Rule 1S-2.0• F.A.C. DS-DE 104(Eff.09/11) APPOINTMENT OF CAMPAIGN TREASURER CITY OF BOYNTON BEACH AND DESIGNATION OF CAMPAIGN CITY CLERK'S OFFICE DEPOSITORY FOR CANDIDATES F.S.) JUN —I AN 9: Q7 (Section 106.021(1), (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): 0 Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office,box or street, city, state, zip Golene L Gordon code) PO BOX 4303 Boynton Beach FL 33426 4. Telephone 5. E-mail address (561 ) 853-5959 electggordon@gmail.com r 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Mayor, City of Boynton Beach applicable: ❑ My intent is to run as a Write -In candidate. 8. If a candidate for aap 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. 1 have appointed the following person to act as my ❑X Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Golene L Gordon 11. Mailing Address 12. Telephone PO BOX 4303 ( 561 ) 853-5959 13. City 14. County 15. State 16. Zip Code 17. E-mail address 1 Boynton Beach Palm Beach IFL 133426 electggordon@gmail.com 18. 1 have designated the following bank as my ❑X 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 133426 Boynton Beach I Palm Beach IFL UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE 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 06/01/2018 X C 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1 Golene L Gordon , do hereby accept the appointment (Please Print or Type Name) designated above as: X❑ Campaign Treasurer ❑ Deputy Tr sur r. 06/01/2018 X Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 13-2.0001, F.A.G. RESIDENCY REQUIREMENTS I, (Print Name) I , candidate for of the City (Mayo /Commissioner District #) 6VV4% Beach, have received, read and understand the residency requirements of Article II of the Charter of the City of Boynton Beach. _ (Signature of Candidate) U LU Q Wit � �. m :z o CD =.r (Date) w — ,� U CO ` L -- y CO 11/12/2013 12:31 PM S:\CC\WP\ELECTION\Year 2014\Information Packets\RESIDENCY REQUIREMENTS STATEMENT.doc STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) 1, Golene L Gordon , candidate for the office of Mayor, for the City of Boynton Beach FL ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. Signature of Candidate 11161111 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 isa 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 (05111) If