Professional Documents
Culture Documents
Joint Filing
DECLARANT
Separate Filing
DURENS
LEWIS
D.
(Family Name)
(First Name)
(M.I.)
Not Applicable
SENIOR TAS
POSITION:
:
ADDRESS:
AGENCY/OFFICE:
COMMISSION ON AUDIT
OFFICE ADDRESS:
COMMONWEALTH AVENUE,
QUEZON CITY
QUEZON CITY
N/A
SPOUSE:
(Family Name)
(First Name)
N/A
POSITION:
(M.I.)
AGENCY/OFFICE:
OFFICE ADDRESS:
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME
DATE OF BIRTH
AGE
N/A
N/A
N/A
Real Properties*
DESCRIPTION
KIND
EXACT
ASSESSED
CURRENT
(e.g. residential,
commercial, industrial,
agricultural and mixed
use)
LOCATION
VALUE
FAIR MARKET
HOUSE AND
LOT
RESIDENTIAL
ACQUISITION
ACQUISITION
COST
VALUE
(As found in the Tax Declaration of
Real Property)
UNIVERSITY HOMES,
BRGY. KAWAYAN,
CATARMAN,
NORTHERN SAMAR
P 300,000.00
P 500,000.00
YEAR
MODE
HOUSING
1997
LOAN
Subtotal:
b. Personal Properties*
DESCRIPTION
YEAR ACQUIRED
P 310,000.00
P 310,000.00
ACQUISITION
COST/AMOUNT
VARIOUS
VARIOUS
GADGETS
PERSONAL EFFECTS
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P 50,000.00
P 260,000.00
P 20,000.00
P 530,000.00
VARIOUS
VARIOUS
BOOKS/MAGAZINES
CASH IN BANK
Subtotal :
TOTAL ASSETS (a+b):
* Additional sheet/s may be used, if necessary.
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P 530,000.00
P 840,000.00
2. LIABILITIES*
NATURE
NAME OF CREDITORS
OUTSTANDING BALANCE
NONE
TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities =
NONE
P 143,000.00
BUSINESS ADDRESS
NATURE OF BUSINESS
INTEREST &/OR FINANCIAL
CONNECTION
DATE OF ACQUISITION OF
INTEREST OR CONNECTION
N/A
N/A
N/A
N/A
RELATIONSHIP
POSITION
TERESITA PERALTA
AUNT
TRANSPORTATION
SECTION CHIEF
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:
(Signature of Co-Declarant/Spouse)
Government Issued ID:
ID No.:
Date Issued:
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N/A
day of
_______________________________________
(Person Administering Oath)
Page 4 of ___