1 SALN 2015 - 1ocon

Download as xls, pdf, or txt
Download as xls, pdf, or txt
You are on page 1of 3

Revised as of January 2015

Per CSC Resolution No. 1500088


Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH


As of December,2015
(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 Separate Filing Not Applicable

DECLARANT: OCON, IRENEA B. POSITION: Principal I


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DepEd-Bacnor NHS
OFFICE ADDRESS: Bacnor West,Burgos,Isabela
ADDRESS: Muñoz West, Roxas, Isabela

SPOUSE: OCON, JIMMY I. POSITION: Barangay Kagawad


(Family Name) (First Name) (M.I.) AGENCY/OFFICE: LGU
OFFICE ADDRESS: Muñoz west, Roxas, Isabela

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEHOLD

NAME DATE OF BIRTH AGE

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. Real Properties*
CURRENT FAIR
DESCRIPTION KIND ASSESSED VALUE ACQUISITION
MARKET VALUE
EXACT ACQUISITION

(e.g., residential, LOCATION COST


(e.g. lot, house and commercial,
lot, condominium, industrial, (As found in the Tax Declaration of Real Property) YEAR MODE
and improvements) agricultural and
mixed used)

House & Lot Residential Muñoz West 25,000.00 25,000.00 1991 purchased 450,000.00

Lot Agricultural Muñoz West 40,150.00 573,570.00 2005 purchased 550,000.00

Subtotal: 1,000,000
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT
Furniture/Appliances/Jewelries 1992-2009 57,000.00
Motorcycle (Suzuki) 2009 56,000.00
Kuliglig 2011 45,000.00
Rice Threser 2012 110,000.00
Adventure 2014 360,000.00
Salary 2015 406,308.00
Subtotal: 1,034,308
TOTAL ASSETS (a+b): 2,034,308
* Additional sheet/s may be used, if necessary.

Page 2 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Consol Loan GSIS 280,000
Salary Loan PR Bank 100,000
Agricultural Loan Producers Bank 300,000
Salary Loan MATMAS 180,000
Salary Loan CitySavings 100,000
TOTAL LIABILITIES: 960,000
NET WORTH: Total Assets less Total Liabilities = 1,074,308

* Additional sheet/s may be used, if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS


(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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF


ENTITY/BUSINESS INTEREST & / OR FINANCIAL INTEREST OR CONNECTION
ENTERPRISE CONNECTION

N/A

RELATIVES IN THE GOVERNMENT


(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
ANACLETA B. GAMIDO SISTER T-3 DepEd-Roxas West Central School
CARIDAD G. GABASAN COUSIN T-3 DepEd-Marcos Elem. School
ALMA B. JIMENA COUSIN T-1 DepEd - Muñoz NHS
GRACE A.BARUT COUSIN T-1 DepEd-Roxas West Central School
EMERSON G.CORPUZ NEPHEW T-1 DepEd-Muños NHS

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 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: February 23, 2015

(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: PRC Government Issued ID:


ID No: 03340036 ID No.: 023126030-3
Date Issued: 3/16/1998 Date Issued:

SUBSCRIBED AND SWORN to before me this 23th day of February,2015, affiant exhibiting to me the above-stated
government issued identification card.

MADELYN L. MACALLING,Ph. D.
(Person Administering Oath)

Page 2 of 2
SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
As of
(Sample additional sheet/s for the exclusive properties of the declarant's spouse and unmarried children
below eighteen (18) years of age living in declarant's household)

NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:

ASSETS, LIABILITIES AND NETWORTH

1. ASSETS
a. Real Properties*
ASSESSED CURRENT FAIR
DESCRIPTION KIND VALUE MARKET VALUE ACQUISITION

(e.g. lot, house and lot,


(e.g., residential, LOCATION ACQUISITION COST
commercial, industrial, (As found in the Tax Declaration of Real
condominium, and agricultural and mixed Property) YEAR MODE
improvements) used)

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT

2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS


NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST DATE OF ACQUISITION OF
ENTERPRISE & / OR FINANCIAL INTEREST & / INTEREST OR CONNECTION
OR FINANCIAL CONNECTION

Page _____ of ______

You might also like