Revised as of J

Per CSC Resolu

Promulgated o

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of 31-Dec-19
(Required by R.A. 6713)

Note: Husband and wife who are both public officials and employees may file the required statements jointl
Joint Filing X Separate Filing Not Applicable
DECLARANT: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
OFFICE ADDRESS:
ADDRESS: San Jose, Alfonso Lista,, IFUGAO

SPOUSE: POSITION: N/A

(Family Name ) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT'S HOUSEH
NAME DATE OF BIRTH
N/A N/A

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 MARKET ACQUISIT
VALUE
EXACT
(e.g., residential, LOCATION
(e.g. lot, house and lot,
commercial, industrial, (As found in the Tax Declaration of Real
condominium, and
agricultural and mixed Property) YEAR
improvements)
used)
Res. Lot N/A 1997
Agri. Lot 2009
Res. Lot 2009
Building 1998
Res. Lot 2013
Res. Lot 2013
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUIS
2001
2015
2016

Page 2 of 2
 2008
2010
2011
2014
2015

TOTAL ASSETS (a
2. LIABILITIES*
NATURE NAME OF CREDITORS
LOAN
LOAN
LOAN
LOAN
LOAN

TOTAL LIABILITIES:
* Additional sheet/s may be used, if necessary. NET WORTH: Total Assets less Total Liabilities =

Page 2 of 2
 BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
(of Declarant/Declarant's Spouse/Unmarried Children Below Eighteen (18) years of Age Living in Declarant
I/We do not have any business interest or financial connection.
NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS
ENTERPRISE INTEREST & / OR FINANCIAL
CONNECTION

Rental
Rental
Rental
Rental
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

Edwin Santos Brother PO3 High Way

I hereby certify that these are true and correct statements of my assets, liabilities, net worth, business interes
connections, including those of my spouse and unmarried children below eighteen (18) years of age living in my househ
my knowledge, the above-enumerated are names of my relatives in the government within the fourth civil degree of con

I hereby authorize the Ombudsman or his/her duly authorized representative to obtain and secure from all ap
agencies, including the Bureau of Internal Revenue such documents that may show my assets, liabilities, net worth, busi
connections, to include those of my spouse and unmarried children below 18 years of age living with me in my househo
to include the year I first assumed office in government.

Date:

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

Government Issued ID: Government Issued ID:

ID No: ID No.:
Date Issued: Date Issued:

SUBSCRIBED AND SWORN to before me this ____ day of ___________ 20________ , affiant exhibiting to me the above-stated gov
card.

(Person Administering

Page 2 of 2
d as of January 2015
C Resolution No. 1500088
lgated on January 23, 2015

ts jointly or separately.

OUSEHOLD
AGE
N/A

QUISITION
ACQUISITION
COST
MODE

N/A 22,000.00
80,000.00
40,000.00
200,000.00
30,000.00
40,000.00

ACQUISITION COST/AMOUNT
70,000.00
75,000.00
60,000.00

Page 2 of 2
 200,000.00
60,000.00
110,000.00
200,000.00
150,001.00
Subtotal: 575,000.00
SSETS (a+b): 1,075,000.00

OUTSTANDING BALANCE
100,000.00
250,000.00
150,000.00

500,000.00
575,000.00

Page 2 of 2
 clarant's Household)

DATE OF ACQUISITION OF
INTEREST OR CONNECTION

2007
1998
2015
2016

Inso)

GENCY/OFFICE AND ADDRESS

igh Way Patrol Group

interests and financial

household, and that to the best of
e of consanguinity or affinity.

m all appropriate government

th, business interests and financial
ousehold covering previous years

/Spouse)

ted government issued identification

nistering Oath)

Page 2 of 2
 Revised as of Ja
Per CSC Resoluti
Promulgated on

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 chil
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 ACQUISITIO
VALUE MARKET VALUE
(e.g., residential,
EXACT
(e.g. lot, house and lot, commercial, industrial, LOCATION (As found in the Tax Declaration of Real
condominium, and agricultural and mixed Property) YEAR
improvements) used)

b. Personal Properties

DESCRIPTION YEAR ACQUIRED ACQUISIT

2. LIABILITIES
NATURE NAME OF CREDITORS
 BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST
ENTERPRISE & / OR FINANCIAL CONNECTION

Page _____ of ______

Revised as of Ja
Per CSC Resoluti
Promulgated on

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of
(Sample additional sheet/s for the declarant)

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

ASSETS, LIABILITIES AND NETWORTH

1. ASSETS

a. Real Properties
ASSESSED CURRENT FAIR
DESCRIPTION KIND ACQUISITIO
VALUE MARKET VALUE
EXACT
(e.g., residential,
(e.g. lot, house and lot, commercial, industrial, LOCATION (As found in the Tax Declaration of Real
condominium, and agricultural and mixed Property) YEAR
improvements) used)
 Subtotal:
b. Personal Properties
DESCRIPTION YEAR ACQUIRED ACQUISIT

Subtotal:
TOTAL ASSETS (a+b)
2. LIABILITIES
NATURE NAME OF CREDITORS

TOTAL LIABILITIES:

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST

ENTERPRISE & / OR FINANCIAL CONNECTION

Page _____ of ______

 as of January 2015
Resolution No. 1500088
gated on January 23, 2015

ried children

UISITION

ACQUISITION COST
MODE

CQUISITION COST/AMOUNT

OUTSTANDING BALANCE
 DATE OF ACQUISITION OF
INTEREST OR CONNECTION

as of January 2015
Resolution No. 1500088
gated on January 23, 2015

UISITION

ACQUISITION COST
MODE
ubtotal: -

CQUISITION COST/AMOUNT

ubtotal: -
TS (a+b): -

OUTSTANDING BALANCE

DATE OF ACQUISITION OF
INTEREST OR CONNECTION