Professional Documents
Culture Documents
Note: Husband and wife who are both public officials and employees may file the required statements jointly or separately.
Joint Filing Separate Filing Not Applicable
DECLARANT
: Lucena Marilou B POSITION : Police Corporal
(Family Name) (First Name) (M.I.) AGENCY /OFFICE: Philippine National Police
ADDRESS: Prk. 6, Katidtuan, Kabacan, North Cotabato OFFICE ADDRESS: Camp Crame , Quezon City
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
Driyannah Louise L Llaban July 04, 2011 12 yrs old
Denz Nathaniel L Umali July 07, 2014 10 yrs old
Denize Natasha L. Umali March 9, 2019 4 yrs old
Denize Natalia L Umali March 9, 2019 4 yrs old
Denize Ncrishian L Umali August 19, 2020 3 yrs old
ASSETS,LIABILITIESANDNETWORTH
(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarant’s household)
1. ASSETS
a. RealProperties*
N/A
Subtotal: 135,000.00
b. PersonalProperties*
Subtotal :
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2. LIABILITIES*
BUSINESSINTERESTSANDFINANCIALCONNECTIONS
(of Declarant /Declarant’s spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
I/We do not have any business interest or financial connection.
N/A
RELATIVESINTHEGOVERNMENTSERVICE
(Within the Fourth Degree of Consanguinity or Affinity. Include also Bilas, Balae andInso)
I/We do not know of any relative/s in the government service)
NAME OF RELATIVE POSITION RELATIONSHIP NAME OF AGENCY/ OFFICE AND ADDRESS
Ryan O’nell B Lucena Police Staff Sergeant Brother Matalam Municipal Police Station, Matalam, Cotabato
Erwin B. Lucena Surveyor Brother NIA, Amas, Kidapawan City
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 above -
enumerated are names of my relatives in the government within the fourth civil degree on 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.
SUBSCRIBEDANDSWORN to before me this_________day of ________________________, affiant exhibiting to me the above-stated government issued
identification card.
_________________________
(Person Administering Oath)
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Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015
(Sample additional sheet/s for exclusive properties of the declarant’s spouse and unmarried children below
eighteen (18) years of age living in declarants household)
NAME:_____________________________________ POSITION_________________________________________
(Family Name) (First Name) (M.I) Agency/Office____________________________________________
___________________________________________________________________________________________
ASSETS, LIABILITIES AND NETWORTH
(Including those of the spouse and unmarried children below eighteen (18) years of age living in declarant’s household)
1. ASSETS
a. RealProperties*
Subtotal
b. Personal Properties*
Subtotal :
TOTAL ASSETS (a+b):
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
TOTAL LIABILITIES:
BUSINESSINTERESTSANDFINANCIALCONNECTIONS
(of Declarant /Declarant’s spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
I/We do not have any business interest or financial connection.
NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF INTEREST
ENTERPRISE AND/OR FINANCIAL CONNECTION OR CONNECTION
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