SWORN STATEMENTS OF ASSETS, LIABILITIES AND NETWORTH, DISCLOSURE OF

BUSINESS
INTERESTS AND CONNECTIONS AND IDENTIFICATIONS OF RELATIVES IN THE
GOVERNMENT SERVICE
As of December 31, 2014
(Required by R.A. No. 6713)
Name:
DIAZ
JUVY
A.
Position/Income: Teacher III/Php21,436
Surname
First Name M.I.
Address:
Blk. 8 Lot 4, 1st St. Our Ladys Village
Office: DepEd
Bitano Elementary School
Bitano Legazpi City, Albay
Address: Bitano,
Legazpi City
Spouse Name: DIAZ,
ARMANDO
R. (Deceased)
Surname
First Name M.I.
Unmarried Children below 18 years of age
Name
Date of Birth
Dave Clark A. Diaz
December 13,1987
Richard Kenneth A. Diaz
July 20,1992

A. ASSETS, LIABILITIES AND NETWORTH

1. ASSETS
a. Real Properties
Kind
Location
Year Acquired
Mode of Acquisition
Assessed Value
FMV Current
Acquisition Cost

Land, bldg.etc.
Improvements
House & Lot

OLV, Bitano
1996
Purchased
Php 300,000.

Lot
OLV,Bitano
1998
Purchased
180,000.

House
OLV,Bitano
2003
Purchased

Php 160,000.00

House
OLV, Bitano
2009
Purchased

280,000.00

Php
920,000.00

b. Personal and other Properties:

Kind

Year Acquired

Acquisition Cost

PC and Printer

2000- 2005

Home Appliances and

Furnitures

2000-2005

101,000.00

Laptop (2)

2007,2009

67,000.00

Home Appliances, PC

2008,2009

2. LIABILITIES (Loans,

Php

47,000.00

83,000.00

Php 298,900.00

mortgages, et.)

NATURE
AMOUNT
Pag-Ibig Multipurpose Loan
Php 40,000.00
GSIS Consolidated Loan
70,000.00
Pag-Ibig Housing Loan
120,000.00
Php
Php

230,000.00

Networth (Total Assets(a +b) less

total

988,000.00

B. BUSINESS I NTEREST AND FINANCIAL CONNECTIONS

Do you have business interest and other financial connections including those
of your spouse and unmarried children below 18 years of age living with you
in your household?

X No _____Yes
Name

If yes, give particulars:

Name of Firm/
Company

Address

Nature of
Business
and /or
Financial
Connection

Date of
Acquisition of
Connection

NONE

C. IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE

To the best of your knowledge are you related to the fourth degree of
consanguinity of affinity to anyone working in the government? X Yes,___ No. If
yes, give particulars:
NAME

POSITION

RELATIONSHIP

NAME/ADDRESS OF
OFFICE

I hereby certify to the best of my knowledge and information, that these

statements of my assets, liabilities, net worth, business interests and financial
connections, including those of my spouse and unmarried children below 18
years of age and names of my relatives in the government as December 31,
2014, as required by and in accordance with Republic Act 6713.
I hereby authorize the Ombudsman of his duty authorized representative to
obtain and secure from all appropriate government agencies including the
Bureau of Internal Revenue, such documents that they may show my assets,
liabilities, net worth, business interest 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
the government.
Date: January 15,2015
_______________________
Signature of Spouse
TIN:
Comm.Tax Cert.No. :
Issued at:
Date on:

_______________________
Signature of Employee
TIN: 915-802-436
Comm. Tax Cert.No. : 26658174
Issued at: Legazpi City
Date on: January 7, 2015

SUBSCRIBED AND SWORN TO before me this _____________ day of January,

2015, affiant exhibiting his/ her Residence Tax Certificate as indicted above.

MA. DULCE G.POBRE

Administrative Officer V