REPUBLIC OF THE PHILIPPINES PROV PROVIN INCE CE OF NEGR NEGRO OS ORI ORIENT ENTAL CITY OF DUMAGUETE }
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SWORN STATEMENT OF CAPITAL
I, Sheila Marie Rose Lara, Filipino, of legl ge, !i"# $$%e&& " Pipi, D'(g'e"e Ci"), Neg%o& O%ien"l, f"e% #*ing +een &!o%n in o %$ne !i"# l! $el%e& "#"./ I ( "#e '"#o%i0e$ %ep%e&en""i*e of T#e O%gni Lol1& S'pe%io% Ven"'%e& In/, !#i# i& $'l) %egi&"e%e$ !i"# "#e Se'%i"ie& n$ E2#nge Co((i&&ion 3SEC4 !i"# Co(pn) Reg/ No/ CS.56789:;/ 5/ T#" T#" T#e O%gni O%gni Lol1 Lol1&& S'pe%i S'pe%io% o% Ven"'%e& n"'%e& In/, In/, #& "#e follo! follo!ing ing ITEMI< ITEMIUIPMENT AND UTENSILS / . +ig foo" ?! @ fo% oo?ing +/ . &(ll ?! @ fo% oo?ing / . &le @ fo% !eig#ing $/ Glo*e& @ fo% #n$ p%o"e"ion e/ 8 *''( pl&"i @ fo% $%)ing p?ing f/ S"inle&& +&in @ p%ep%ing oo g/ S"% S"%in ine% e%,, Ap%on p%on,, l$l l$le, e, #i%n #i%ne" e" (i&ellneo'& #/ Bolo fo% '""ing TOTAL COST OF E>UIPMENT
Php 50,000.00
P.7,:8/ 6,89./ .,8/ .,7;9/ 9,:8/ 88/ 6/ :/ 32,29.00 Php 32,29.00 Php 5,000.00 Php !5,000.00
III/ RENT E=PENSE IV/ SALARIES E=PENSE TOTAL
Php !02,29.00
6/ T#" ini"il !o%?ing pi"l %e'i%e(en" fo% "#e fi%&" . )e% of ope%"ion i& Fif") T#o'&n$ pe&o& 3P8,/4 7/ I ( e2e'"ing "#i& ffi$*i" "o ""e&" "o "#e "%'"# of "#e fo%egoing n$ fo% !#"e*e% legl p'%po&e& i" () &e%*e/ THE AFFIANT SAYS NOTHING FURTHER/
IN ITNESS HEREOF, I #*e &igne$ "#i& on No*e(+e% 59, 5.8 in D'(g'e"e Ci"), Neg%o& O%ien"l, P#ilippine&/
S"EILA MARIE ROSE LARA Affin"
SUBSCRIBED n$ &!o%n "o +efo%e (e, in D'(g'e"e Ci"), Neg%o& O%ien"l, P#ilippine& on No*e(+e% 59, 5.8, ffin" e2#i+i"ing "o (e #e% Co(('ni") T2 Ce%"ifi"e No/ .5678 i&&'e$ in D'(g'e"e Ci") on No*e(+e% .8, 5.8/
AC#NOWLE$%MENT
REPUBLIC OF THE PHILIPPINES4 CITY OF DUMAGUETE4 S"EILA MARIE ROSE LARA pe%&onll) ppe%e$ +efo%e (e on No*e(+e% 59, 5.8 in D'(g'e"e Ci") n$ e2#i+i"e$ #e% Co(('ni") T2 Ce%"ifi"e No/ .5678 i&&'e$ in D'(g'e"e Ci") on No*e(+e% .8, 5.8/
no!n "o (e "o +e "#e &(e pe%&on !#o e2e'"e$ "#e fo%egoing S!o%n S""e(en" of Cpi"l n$ &#e ?no!le$ge$ "#" "#e &(e i& #e% f%ee n$ *ol'n"%) " n$ $ee$/
I HAVE AFFI=ED MY SIGNATURE AND NOTARIAL SEAL/
Mar&ilie M. Ser'a No"%) P'+li M) o((i&&ion e2pi%e& on Dee(+e% 6., 5.9 PTR No/ .56789 i&&'e$ n/ 6, 5.8 IBP No/ 8765. Roll No/ 765.
Do/ No/ - Pge No/ - Boo? No/ - Se%ie& of 5.8-
