Escolar Documentos
Profissional Documentos
Cultura Documentos
As of ____________________
December 31, 2013
(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
Separate Filing
GALES
KENNETH
B.
(Family Name)
(First Name)
(M.I.)
Not Applicable
POSITION:
ADMINISTRATIVE AIDE 1
AGENCY/OFFICE:
LGU-BALANGIGA/MSWD
P. DURAN ST., MUN. BLDG.
BALANGIGA, E. SAMAR
:
ADDRESS:
OFFICE ADDRESS:
SPOUSE:
POSITION:
N/A
(M.I.)
AGENCY/OFFICE:
N/A
N/A
OFFICE ADDRESS:
N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME
DATE OF BIRTH
AGE
N/A
N/A
N/A
1. ASSETS
a.
Real Properties*
DESCRIPTION
KIND
(e.g. residential,
commercial, industrial,
agricultural and mixed
use)
N/A
N/A
LOCATION
ASSESSED
CURRENT FAIR
VALUE
MARKET VALUE
ACQUISITION
N/A
N/A
N/A
ACQUISITION COST
YEAR
MODE
N/A
N/A
N/A
Subtotal:
b. Personal Properties*
DESCRIPTION
N/A
YEAR ACQUIRED
ACQUISITION COST/AMOUNT
2012 PRESENT
10,000.00
2012
Subtotal :
TOTAL ASSETS (a+b) :
Php
10,000.00
10,000.00
2. LIABILITIES*
NATURE
NAME OF CREDITORS
OUTSTANDING BALANCE
N/A
N/A
N/A
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N/A
TOTAL LIABILITIES:
NAME OF
ENTITY/BUSINESS
ENTERPRISE
NATURE OF BUSINESS
INTEREST &/OR FINANCIAL
CONNECTION
DATE OF ACQUISITION OF
INTEREST OR CONNECTION
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 knowledge, the aboveenumerated 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:
_________________________________
(Signature of Declarant)
Government Issued ID:
ID No.:
Date Issued:
LGU EMPLOYEES ID
11-02
JUNE 20, 2011
(Signature of Co-Declarant/Spouse)
Government Issued ID:
ID No.:
Date Issued:
N/A
SUBSCRIBED AND SWORN to before me this _____ day of _____________, affiant exhibiting to me the above-stated government
issued identification card.
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