Documente Academic
Documente Profesional
Documente Cultură
As of 31 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
DECLARANT
:
ADDRESS:
Separate Filing
Paulino
Jenny Lyn
(Family Name)
(First Name)
R.
Not Applicable
POSITION:
(M.I.)
Teacher III
AGENCY/OFFICE:
Department of
OFFICE ADDRESS:
Education/BULAC NHS
Bulac, Talavera, Nueva
Ecija
SPOUSE:
(Family Name)
N/A
(First Name)
POSITION:
(M.I.)
AGENCY/OFFICE:
OFFICE ADDRESS:
Ecija
N/A
N/A
N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME
DATE OF BIRTH
AGE
SIGNATU
RE OF
ADMINIS
TERING
OFFICER
N/A
ASSETS, LIABILITIES AND NETWORTH
(Including those of the spouse and unmarried children below eighteen (18) years of age living in declarants household)
1. ASSETS
SIGNATU
RE OF
SPOUSE
a. Real Properties*
DESCRIPTION
KIND
(e.g. residential,
lot, condominium
commercial,
and improvements)
LOCATION
industrial,
ASSESSED
CURRENT FAIR
VALUE
MARKET VALUE
ACQUISITION
ACQUISITION
COST
YEAR
agricultural and
MODE
Real Property)
mixed use)
N/A
N/A
Subtotal
_________
_________
_________
_________
SIGNATU
RE OF
DECLAR
ANT
b. Personal Properties*
DESCRIPTION
YEAR ACQUIRED
ACQUISITION COST/AMOUNT
Various Years
Various Years
60,000.00
50,000.00
_________
_________
_________
_
_________
_________
_________
Subtotal :
TOTAL ASSETS (a+b):
110,000.00
Php 110,000.00
2. LIABILITIES*
NATURE
NAME OF CREDITORS
OUTSTANDING BALANCE
N/A
N/A
N/A
TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities =
* Additional sheet/s may be used, if necessary.
Php 110,000.00
DATE OF ACQUISITION OF
ENTITY/BUSINESS
NAME OF
BUSINESS ADDRESS
INTEREST OR
ENTERPRISE
CONNECTION
CONNECTION
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
RELATIONSHIP
POSITION
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
SIGNATU
RE OF
ADMINIS
TERING
OFFICER
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
SIGNATU
RE OF
SPOUSE
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.
_________
_________
_________
_________
SIGNATU
RE OF
DECLAR
ANT
(Signature of Co-Declarant/Spouse)
Government Issued ID:
ID No.:
Date Issued:
SUBSCRIBED AND SWORN to before me this 10 day of May 2016 affiant exhibiting to me the above-
_________
_________
_________
_
_________
_________
_________
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