Joint Filing
DECLARANT: MARIANO (Family Name) SAN ANDRES I, NUEVA ECIJA MARIANO (Family Name) RAFAEL (First Name) QUEZON,
Separate Filing
V. (M.I.)
Not Applicable
HOUSE MEMBER HOUSE OF REPRESENTATIVES 405 SWA, HOUSE OF REPRESENTATIVES, BATASAN, QUEZON CITY PEASANT WOMEN LEADER NATIONAL FEDERATION OF PEASANT WOMEN (AMIHAN) 82-C MAPANG-AKIT ST., BRGY. CENTRAL, QUEZON CITY
ADDRESS:
SPOUSE:
P. (M.I.)
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME DATE OF BIRTH AGE
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 a. Real Properties*
KIND
(e.g. residential, commercial, industrial, agricultural and mixed use)
DESCRIPTION
(e.g. lot, house and lot, condominium and improvements)
LOCATION
ASSESSED VALUE
ACQUISITION COST
N/A
2005 2010
N/A
TOTAL LIABILITIES: N/A NET WORTH : Total Assets less Total Liabilities = PhP 92,507.15
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N/A
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: ________APRIL 25, 2013_____
(Signature of Declarant) Government Issued ID: ID No.: Date Issued: HOUSE OF REPRESENTATIVES C-627 JULY 1, 2010
(Signature of Co-Declarant/Spouse) Government Issued ID: ID No.: Date Issued: N/A N/A N/A
day of
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