Janet Gibson 470Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print In ink.
Date of election If applicable: D Amendment (Explain Below)
(Month, Day, Year)
1. Statement Covers Calendar Year 20 Q_/_ .
2. Officeholder or Candidate Information 3. Office Sought or Held
JURISDICTION (LOCATION)
CITY STATE ZIP CODE
?~t;oJ
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX/E-MAILADDRESS
670 ·-6"~1-;'.,-?3,:Z,;
4. Committee Information
DISTRICT NUMBER
(IF APPLICABLE)
List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy.
COMMITTEE NAME AND l.D. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
5. Verification
I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $1,000 and that I will spend less than $1,000 during
the calendar year and that I have used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of
California that theforego~; is true and correct. ---::---
__·
DATE ( SIGNATUREOFOFFICEHOLDERORCANDIDATE
Form 470/470 Supplement (12/99)
For Technical Assistance: 916/322-5660
State of California