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 September 2024
(Required by R.A. 6713)111
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 TABANGIN LOVELY JOY M. POSITION: SUBSTITUTE TEACHER
:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: SMNES
ADDRESS: SAN MANUEL NORTE, AGOO, LA OFFICE ADDRESS: SAN MANUEL NORTE, AGOO, LA
UNION UNION
SPOUSE: TABANGIN JULIETO JR. C. POSITION: N/A
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A
N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE
HERSHEY AVEGAIL M. TABANGIN 05/14/2015 9
KISSES AMBHERLY M. TABANGIN 03/29/2021 3
CADBURY ALYSHEYKISS M. TABANGIN 05/27/2024 3 MONTHS
N/A N/A 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*
DESCRIPTIO KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION
N (e.g. residential, LOCATION VALUE MARKET COST
commercial,
(e.g. lot, house and industrial, agricultural VALUE
lot, condominium and mixed use) (As found in thNA/e Tax Declaration of
and improvements)
Real Property)
YEAR MODE
N/A N/A N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A N/A N/A
Subtotal: N/A
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
CELLPHONEVIVO Y17S 2023 7000
CELLPHONEVIVO Y12A 2022 7000
CELLPHONE VIVI Y11 2020 7000
Subtotal : 21000
TOTAL ASSETS (a+b): 21000
* Additional sheet/s may be used, if necessary.
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2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING
BALANCE
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
N/A N/A N/A
TOTAL LIABILITIES: N/A
NET WORTH : Total Assets less Total Liabilities = N/A
* 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 CONNECTION
ENTERP/ARISE CONNECTION
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A 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
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A 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
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 _____________________________, affiant exhibiting to me the
above-stated government issued identification card.
_______________________________________
(Person Administering Oath)
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