Revised as of January
2015
Per CSC Resolution No.
1500088
Promulgated on January 23,
2015
SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH
As of December 2019
(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
PATIÑO ARAH JANE T.
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/FHINHS
Zone II, Lanuza, Surigao del Sur
ADDRESS: PUROK RIVERSIDE II, BARANGAY UNIDAD, CAGWAIT, SURIGAO DEL SUR OFFICE ADDRESS:
SPOUSE: POSITION:
(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
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 ACQUISITION ACQUISITION COST
(e.g. lot, house and lot, condominium (e.g. residential, commercial,
an Zd improvements) industrial, agricultural and LOCATION VALUE FAIR
mixed use)
MARKET
VALUE
(As found in the Tax Declaration of
YEAR MODE
Real Property)
Subtotal:
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
Gadgets & Appliances (laptop, cellphone, water dispensers, washing machine) 2018 43,598.00
Furniture 2018 14, 500.00
Jewelries 2018 15,300.00
Clothing 2018 15,000.00
Subtotal : 88,398.00
*Additional sheet/s may be used, if necessary.
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2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Salary loan East West Bank 75,000.00
TOTAL LIABILITIES: P 75,000.00
NET WORTH : Total Assets less Total Liabilities = P 13,398.00
* 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 ENTITY/BUSINESS ENTERPRISE BUSINESS ADDRESS NATURE OF BUSINESS INTEREST &/OR DATE OF ACQUISITION OF INTEREST OR
FINANCIAL CONNECTION CONNECTION
RELATIVES IN THE GOVERNMENT SERVICE
(Within the Fourth Degree of Consanguinity or Affinity. Include also Bilas, Balae and Inso)
NAME OF RELATIVE RELATIONSHIP POSITION NAME OF AGENCY/OFFICE AND ADDRESS
I/We do not know of any relative/s in the government service)
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:
(Signature of Declarant) -(Signature of Co-Declarant/Spouse)
Government Issued ID: Government Issued ID:
ID No.: ID No.:
Date Issued: Date Issued: `
SUBSCRIBED AND SWORN to before me this of , affiant exhibiting to me the above-stated government issued identification card.
________________________________________
(Person Administering Oath)
Doc. No. _____
Page No._____
Book No._____
Series of _____
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