Revised as of January

2015
Per CSC Resolution No.
1500088
Promulgated on January
23, 2015

SWORNSTATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of DECEMBER 31, 2020
(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 Separate Filing Not Applicable

DECLARANT: Mendones Jim Rushty L POSITION: Patrolman

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: 2nd PMFC, Pampanga PPO
ADDRESS: Officer’s Village Camp Olivas, City of San OFFICE ADDRESS: Brgy. Panipuan, Mexico
Fernando, Pampanga Pampanga

SPOUSE: N/A POSITION: N/A

(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
OFFICE ADDRESS:

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S

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 declarant’s household)
1. ASSETS
a. Real Properties*

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

(e.g. lot, house and (e.g. residential, LOCATION VALUE MARKET VALUE COST
lot, condominium commercial, industrial,
and improvements) agricultural and mixed (As found in the Tax Declaration of
Real Property)
YEAR MODE
use)

N/A

Subtotal: PHP 0.00

b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

Gadgets 2017-2019 Php 82,989.00

Appliances 2018 Php 20,000.00
Appliances 2020 Php 15,000.00

Page 1 of 2
 Cash in bank 2020 Php 30,000.00
Subtotal : PHP 147,989.00

PHP 147,989.00
TOTAL ASSETS (a+b):
* Additional sheet/s may be used, if necessary.

Page 2 of 2
2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Salary Loan AFPSLAI Php 463,380.00

TOTAL LIABILITIES: PHP 463,380.00

NET WORTH : Total Assets less Total Liabilities = PHP -315,391.00
* Additional sheet/s may be used, if necessary.

BUSINESS, INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant /Declarant’s spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
I/We do not have any business interest or financial connection.

NAME OF BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

ENTITY/BUSINESS INTEREST &/OR FINANCIAL INTEREST OR
ENTERPRISE CONNECTION CONNECTION

N/A

RELATIVES IN THE GOVERNMENT SERVICE

(Within the Fourth Degree of Consanguinity or Affinity. Include 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
Floritess M Lansang Auntie MTI DEPED/Florida, Pampanga East District
Froilan B Mendones Father PEMS PNP, Pampanga PPO
Marvin Jan L Mendones Brother PIO Pangasinan Capital/Lingayen Pangasinan
Jara Judith L Mendones Sister PEO Pangasinan Capital/Lingayen Pangasinan

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 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
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: January 20, 2021

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

Government Issued ID: PNP ID Government Issued ID:

ID No.: 19A090379 ID No.:
Date Issued: 1/9/2019 Date Issued:

SUBSCRIBED AND SWORN to before me this 20th day of JANUARY 2020 affiant exhibiting to me the
above-stated government issued identification card.
PLTCOL PAUL IÑIGO GAMIDO
Force Commander, 2nd PMFC
_______________________________________
RECEIVED BY:
______________________ Page 3 of 2
Name: ______________________

Date: ______________________
 (Person Administering Oath)

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