Sie sind auf Seite 1von 3

STATEMENT OF ASSETS, LIABILITIES AND NET WORTH AND DISCLOSURE OF BUSINESS INTERESTS, FINANCIAL CONNECTIONS AND RELATIVE/S IN THE

GOVERNMENT SERVICE As of December 31, 2011 (Required by R.A. Nos. 3019 and 6713) (Note: Husband and Wife who are both public officials or employees may file the required statements jointly or separately.) Jointly filed. Separately filed. Name _MEDRANO___ _PAULINO______M.____________ (Surname) (First Name) (Middle Initial) Address ____________________________________________ ____________________________________________ I am married. I am not married. Position ____________N/A_____________________________ Office _________________________________________ Office Address __________________________________ __________________________________________ Office Position ___Elementary School Principal IV_____ Pres. Corazon C. Aquino Elem. Sch.____

Office Address __________________________________ ___________________________________________

Spouse _____________N/A______________________________ (Surname) (First Name) (Middle Initial)

Unmarried Children below 18 years of age living in his/her household: (use additional sheet/s, if necessary) Name Date of Birth 1. __________________N/A___________________ 2. _____________________________________________ 3. _____________________________________________ ______________________N/A_____________ ___________________________________ ___________________________________

I have no children below 18 years of age living in my household. ASSETS, LIABILITIES AND NET WORTH I. ASSETS (including that of declarants spouse and unmarried children below 18 years of age living in his/her household) A. REAL PROPERTY/IES (use additional sheet/s, if necessary) KIND NATURE OF LOCATION ACQUISITION ASSESSE (Res./Comm./ PROPERTY D VALUE MODE YEAR Agri., etc.) (Paraphernal,
conjugal or community)

FAIR MARKET VALUE

ACQUISITION COST*
Land, Building, others Improvement/s

House & lot House & lot ISUZU Sportivo

Paraphernal Paraphernal Paraphernal

Nova Las Pias Nova

1999 -doInstallment

1990

2005 2010

110,000 500,000 1,200,000

1 million 500,000 1,200,000 TOTAL:2,700,00 0

B. PERSONAL PROPERTY/IES AND OTHER ASSETS (use additional sheet/s, if necessary) TANGIBLE ACQUISITION ACQUISITION COST* MODE YEAR Furniture cash 1996-Present 100,000 Jewerly, Appliciances cash 2000-Present 150,000 INTANGIBLE bond cash 2011-present 100,000 TOTAL: 350,000 *For computation purposes, use acquisition cost. Properties of unmarried children below 18 years of age living in his/her household shall be excluded as well as the paraphernal/exclusive properties of spouse, in case of separate filing. TOTAL ASSETS (A+B)=___________________________ II. LIABILITIES (including that of declarants spouse and unmarried children below 18 years of age living in his/her household) NATURE NAME OF CREDITOR/S *OUTSTANDING BALANCE Consol loan GSIS 121,903 Personal Loan (installment) ISUZU Company 700,000 Policy Loan GSIS 50,000 Personal (private) 500,000 (use additional sheet/s, if necessary) TOTAL: ___1,371,903___ *In the computation of outstanding balance, properties of unmarried children below 18 years of age living in his/her household shall be excluded as well as the paraphernal/exclusive properties of spouse, in case of separate filing. III. NET WORTH (TOTAL ASSETS (I) LESS TOTAL LIABILITIES (II) = NET WORTH (III)

TOTAL NET WORTH: 1,678,097 AMOUNT AND SOURCES OF GROSS INCOME (ALL amounts received from ALL sources for the preceding calendar year) NATURE SOURCES AMOUNT (salary/income, business, etc.) salary DepEd 459,720 allowance City Government 54,000
(use additional sheet/s, if necessary)

TOTAL: ___513,720___ AMOUNT OF PERSONAL AND FAMILY EXPENSES (for the preceding calendar year) ESTIMATED FAMILY EXPENSES AMOUNT 30,000 Food & Shelter 20,000 Telephone, Water, Electric TOTAL : _______________ AMOUNT OF INCOME TAXES PAID (for the preceding calendar year)

PERSONAL EXPENSES Clothing Celphone Load


(use additional sheet/s, if necessary)

ESTIMATED AMOUNT 60,000 82,800 TOTAL : __142,800__

NATURE Compensation tax withheld ( annual) Business Income Other Income


(use additional sheet/s, if necessary)

AMOUNT 79,386.60

TOTAL : ____79,386.60___

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS (Declarant/Spouse/Unmarried Children below 18 years of age living in the household of declarant) (Use Additional Sheet/s, if necessary) I/We dont have any business interests and financial connections. Name of Entity/Business Business Address Nature of Business Enterprise Interest and/or Financial Connection N/A N/A N/A Date of Acquisition of Interest or Connection N/A

RELATIVE/S IN THE GOVERNMENT (Up to the 4th civil degree of relationship, either by consanguinity or affinity, including bilas, inso and balae) (Use Additional Sheet/s, if necessary) I/We dont know of any relative/s in Government. Name of Relative Relationship N/A N/A Position N/A Name of Office/Address N/A

I/We hereby certify that these are my/our true and detailed assets, liabilities, net worth, amount and sources of income, personal and family expenses, amount of income taxes paid, business interests, and financial connections, including those of my spouse and my/our children below 18 years of age living in my household, and the name/s of my relative/s in the Government, as of December 31, __________, as required by and in accordance with Republic Act No. 3019 and 6713. I/We hereby authorize the Ombudsman or his duly authorized representative to obtain and secure from all appropriate agencies, including the Bureau of Internal Revenue, such documents that may show such assets, liabilities, net worth, business interests, and financial connections, including those of my spouse and my/our children below 18 years of age living in my household, covering previous years, and if possible, including the year I/we first assumed office in Government. I/We further undertake to produce all supporting documents for each of the entries herein made when required. Declarants Signature: PAULINO M. MEDRANO JR Date: 1-31-2011 _____________________________ Date: ____________________________

(For Separate Filing) Spouses Signature: _________________________ Date: ____________________________ SUBSCRIBED AND SWORN TO before me on this _______ day of ______________, 20______, affiant(s) exhibiting his/her/their tax identification number(s) 140-643-567 and employee number(s) 219694 .

______________________________ (Person Administering Oath)

Das könnte Ihnen auch gefallen