SWORN STATEMENT OF ASSETS, LIABILITIES, AND NETWORTH B"

DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

AND IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE
As of DECEMBER 31, 2012
(Required by R.A. 6713)
Name:

Position/Income ___________________________

_____________________________________
(Surname)

(First Name)

(M.I.)

_____________________________________

PUBLIC ATTORNEY'S OFFICE

________________________________
Office Address
Ground Floor, Hall of Justice
________________________________

_____________________________________

Pulung Maragul, Angeles City

________________________________

Office
Address:

Spouse

_____________________________________
(Surname)

(First Name)

Position

________________________________

Office

________________________________

(M.I.)

Unmarried Children below 18 years of age

Date of Birth

__________________________________________
A. ASSETS, LIABILITIES AND NETWORTH
1. ASSETS
A. Real Properties
KIND

LOCATION

YEAR
ACQUIRED

MODE OF
ACQUISITION

NATURE OF
PROPERTY
(paraphernal
conjugal or
community

ASSESSED CURRENT
VALUE
FAIR
MARKET
VALUE

TOTAL

ACQUISITION COST
LAND
BUILDING
ETC.

P _______________________

B. Personal and other Properties

KIND / S

YEAR ACQUIRED

ACQUISITION COST

TOTAL

2.

P _______________________

LIABILITIES (Loans, Mortgages, etc.)

NATURE

NAME OF CREDITORS

NETWORTH [ Total Assets (1a+1b) less

Total Liabilities (2) ]
(NOTE: Please use additional forms/sheets if necessary.
Also, please reproduce this form back to back

AMOUNT

TOTAL

P _______________________

TOTAL

P _______________________

"
ONS
CE

________________

RNEY'S
OFFICE
_________________
,_________________
Hall of Justice

,_________________
Angeles City

_________________

_________________

_________________

QUISITION COST
IMPROVEMENT

__________________

TION COST

__________________

OUNT

__________________

__________________