M1 Waiver of Report 2-4-21 CAMPAIGN TREASURER'S REPORT SUMMARY
(1) GOLENE L GORDON OFINLCEraii ONLY
Name FEB 0 4 2021 1'. S
(2) P.O.BOX 4303
Address (number and street) CITY OF BOYNTON BEACH
BOYNTON BEACH, FL, 33435 CITY CLERKS OFFICE
City, State, Zip Code
❑ Check here if address has changed (3) ID Number:
(4) Check appropriate box(es):
El Candidate Office Sought: MAYOR OF BOYNTON BEACH
❑ 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 01 / 01 /2021 To 01 / 31 2021 Report Type: M1
❑ Original ❑ Amendment El Special Election Report
(6) Contributions This Report (7) Expenditures This Report
Monetary
Cash & Checks $ , , 450 . 00 Expenditures $ , •
Loans $ • Transfers to
Office Account $
Total Monetary $ , •
Total Monetary $
In-Kind $ •
(8) Other Distributions
$ .
(9) TOTAL Monetary Contributions To Date (10) TOTAL Monetary Expenditures To Date
$ , 500 • 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)GOLENE GORDON (Type name)GOLENE GORDON
❑ Individual(only for IE 0 Treasurer 0 Deputy Treasurer 0 Candidate 0 Chairperson(only for PC and PTY)
or electioneering comm.)
C--21
X X �—�
Signature Signature
DS-DE 12(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS
CAMPAIGN TREASURER'S REPORT- ITEMIZED CONTRIBUTIONS
GOLENE GORDON
(1) Name (2) I.D. Number
01 01 2021 01 31 2021 1 1
(3) Cover Period / / through / / (4) Page of
(5) (7) (8) (9) (10) (11) (12)
Date Full Name
(6) (Last, Suffix, First, Middle)
Sequence Street Address& Contributor Contribution In-kind
Number City,State,Zip Code Type Occupation Type Description Amendment Amount
EMMANUEL MOREL
01 20 2021 8123 W00DSLANDING TRAIL
/ / WEST PALM BEACH,
FLORIDA, 33411 I RETIRED CHE $150.00
1
UNITED GROUP ELITE
01 21 2021 AGENCY
/ / 2101 VISTA PARKWAY
WEST PALM BEACH, B CHE $300.00
FLORIDA, 33411
2
/ /
/ /
/ /
/ /
/ /
DS-DE 13(Rev.11/13) SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES