Revised as of January 2015

Per CSC Resolution No. 1500088

Promulgated on January 23, 2015

STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of January 2022
(Required by R.A. 6713)

(Note: Husband and Wife who are both public officials or employees may file the required statements jointly or separately.
Jointly filed. Separately file Not Applicable

Declarant: ADRIANO LEA G Position TEACHER I

(Surname) (First Name) (Middle Initial) Office PURA V. KALAW ELEMENTARY SCHOOL

Address: 55-B C. Aguinaldo St. Proj. 4, Quezon City Office Address 68 F. Salallila St. Proj. 4, Quezon City

Spouse N/A Position N/A

(Surname) (First Name) (Middle Initial) Office N/A

Office Address N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
Name Date of Birth Age
1. N/A N/A N/A
2.
3. _____________________ __________________
4.

ASSETS, LIABILITIES AND NET WORTH

(Including those of the spouse and unmarried children below 18 years of age living in declarant’s household)

I. ASSETS
A. REAL PROPERTIES*
DESCRIPTION KIND ASSESSED CURRENT ACQUISITION
(E.G. LOT, (e.g. VALUE FAIR
HOUSE AND Residential, EXACT MARKET
LOT, CONDO commercial LOCATION VALUE ACQUISITION
AND , industrial, (as found in the Tax YEAR MODE COST
IMPROVEMENTS agricultural
declaration of real
) and mixed
used etc.) property)

N/A N/A N/A N/A N/A N/A N/A N/A

SUBTOTAL: P 0

B. PERSONAL PROPERTIES*
DESCRIPTION YEAR AQUIRED ACQUISITION COST/AMOUNT
Cellphone (Samsung) 2021 P24, 990.00

2021 P16, 000.00

Investment

2019 P37, 000.00

Aircon (Carrier Window Type)

2013 P20, 000.00

Clothes, shoes, accessories

SUBTOTAL: P 97,990.00
TOTAL ASSETS (A+B)= P 97,990.00

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II. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
N/A N/A 00.00

(Additional sheets may be used, if necessary) TOTAL LIABILITIES: P 00.00

NET WORTH: Total Assets Less Total Liabilities = P 97,990.00

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant/Declarant’s Spouse/Unmarried Children below 18 years of Age Living in Declarant’s Household)
I/We do not have any business interests or financial connections.
Name of Entity/Business Business Address Nature of Business Date of Acquisition of
Enterprise Interest and/or Interest or Connection
Financial Connection
N/A N/A N/A N/A

RELATIVES IN THE GOVERNMENT SERVICE

(Within the Fourth Degree of Consanguinity or Affinity, including 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
N/A N/A N/A N/A

I hereby certify that these are true and correct statement of my assets, liabilities, net worth,
business interests, and financial connections, including those of my spouse and unmarried children below
18 years of age living in my household, and that to the best of my knowledge, the above-enumerated are
the 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 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

Date: January 21, 2022

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

Government Issued ID: PRC Government Issued ID: N/A

ID No. 1236522 ID No. N/A
Date Issued: 12/06/2013 Date Issued: N/A

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

_______________________________________
(Person Administering Oath)

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