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 ________________________________
(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: Yaon Mylen B POSITION: Teacher I
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: Deped Lanao del Norte
ADDRESS: Purok 2, Sta Cru OFFICE ADDRESS: Pigcaranga, Tubod,
Lanao del Norte
SPOUSE: Yaon Ramel D. 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
Aaron Jake B. Yaon July 30, 2011 7
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,
(As found in the Tax Declaration of
and improvements) agricultural and mixed YEAR MODE
use) Real Property)
house residential P-1 Lapinig, 50,000 50,000 2015 50,000
Kapatagan, LDN
Subtotal: 50,000
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
Cellphones 2018 20,400
Clothing 2019 30,800
Appliances 2018 80,000
Gym fitness equipment 2018 20,500
Subtotal : 151,700
TOTAL ASSETS (a+b): 201,700
* Additional sheet/s may be used, if necessary.
Page 1 of ___
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Salary loan One Network Bank 200,000
TOTAL LIABILITIES: 200,000
NET WORTH : Total Assets less Total Liabilities = 1,700
* 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 BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF
ENTERPRISE INTEREST &/OR FINANCIAL INTEREST OR CONNECTION
CONNECTION
Peso net computer Iligan City 2015
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
Beverly T. Suson Aunt T-2 DepEd/Kapatagan NHS
Jocelyn T. Bastatas Aunt Councilor/Health Barangay Hall (Saray,Iligan City)
Worker
Jaime Bastatas Uncle Mayor’s Iligan City
bodyguard/retired
police
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: DepEd ID Government Issued ID:
ID No.: REG-2008-19834042 ID No.:
Date Issued: 2017 Date Issued:
SUBSCRIBED AND SWORN to before me this day of , affiant exhibiting to me the above-stated
government issued identification card.
_______________________________________
Page 2 of ___
(Person Administering Oath)
Page 3 of ___
