SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
As of ____________________
December 31, 2013
(Required by R.A. 6713)
Note: Husband and wife who are both public officials and employees may file the required statements jointly or separately.
Joint Filing
DECLARANT
Separate Filing
GALES
KENNETH
B.
(Family Name)
(First Name)
(M.I.)
Not Applicable
POSITION:
ADMINISTRATIVE AIDE 1
AGENCY/OFFICE:
LGU-BALANGIGA/MSWD
P. DURAN ST., MUN. BLDG.
BALANGIGA, E. SAMAR
:
ADDRESS:
OFFICE ADDRESS:
GERONIMA ST., POBLACION 2
BALANGIGA, E. SAMAR
SPOUSE:
POSITION:
N/A
(M.I.)
AGENCY/OFFICE:
N/A
N/A
OFFICE ADDRESS:
N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME
DATE OF BIRTH
AGE
N/A
N/A
N/A
ASSETS, LIABILITIES AND NETWORTH
(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarants household)
1. ASSETS
a.
Real Properties*
DESCRIPTION
KIND
(e.g. lot, house and
lot, condominium
and improvements)
(e.g. residential,
commercial, industrial,
agricultural and mixed
use)
N/A
N/A
LOCATION
ASSESSED
CURRENT FAIR
VALUE
MARKET VALUE
ACQUISITION
(As found in the Tax Declaration of
Real Property)
N/A
N/A
N/A
ACQUISITION COST
YEAR
MODE
N/A
N/A
N/A
Subtotal:
b. Personal Properties*
DESCRIPTION
CLOTHING & ACCESSORIES
N/A
YEAR ACQUIRED
ACQUISITION COST/AMOUNT
2012 PRESENT
10,000.00
LAPTOP COMPUTER (DONATED)
2012
Subtotal :
TOTAL ASSETS (a+b) :
Php
10,000.00
10,000.00
2. LIABILITIES*
NATURE
NAME OF CREDITORS
OUTSTANDING BALANCE
N/A
N/A
N/A
Page 1 of _2__
N/A
TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities = Php 10,000.00
* Additional sheet/s may be used, if necessary.
BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
(of Declarant /Declarants spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarants Household)
NAME OF
ENTITY/BUSINESS
ENTERPRISE
I/We do not have any business interest or financial connection.
BUSINESS ADDRESS
NATURE OF BUSINESS
INTEREST &/OR FINANCIAL
CONNECTION
DATE OF ACQUISITION OF
INTEREST OR CONNECTION
RELATIVES IN THE GOVERNMENT SERVICE
(Within the Fourth Degree of Consanguinity or Affinity. Include also Bilas, Balae and Inso)
I/We do not know of any relative/s in the government service)
NAME OF RELATIVE
RELATIONSHIP
POSITION
NAME OF AGENCY/OFFICE AND ADDRESS
I hereby certify that these are true and correct statements of my assets, liabilities, net worth,
business interests and financial connections, including those of my spouse and unmarried children below
eighteen (18) years of age living in my household, and that to the best of my knowledge, the aboveenumerated are names of my relatives in the government within the fourth civil degree of consanguinity or
affinity.
I hereby authorize the Ombudsman or his/her duly authorized representative to obtain and
secure from all appropriate government agencies, including the Bureau of Internal Revenue such
documents that may show my assets, liabilities, net worth, business interests and financial connections,
to include those of my spouse and unmarried children below 18 years of age living with me in my
household covering previous years to include the year I first assumed office in government.
Date:
_________________________________
(Signature of Declarant)
Government Issued ID:
ID No.:
Date Issued:
LGU EMPLOYEES ID
11-02
JUNE 20, 2011
(Signature of Co-Declarant/Spouse)
Government Issued ID:
ID No.:
Date Issued:
N/A
SUBSCRIBED AND SWORN to before me this _____ day of _____________, affiant exhibiting to me the above-stated government
issued identification card.
Page 2 of _2__
ATTY. CAMILO A. CAMENFORTE
(Person Administering Oath)
Page 3 of _2__
