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 2020
(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 BAJO NIÑA HANNAH TRIXIA D. POSITION: TEACHER I
:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: LUZON NATIONAL HIGH SCHOOL
ADDRESS: PUROK 2, BUSO-BUSO, LAVIGAN OFFICE ADDRESS: LUZON, GOVERNOR GENEROSO
GOVERNOR GENEROSO, DAVAO ORIENTAL DAVAO ORIENTAL
SPOUSE: N/A N/A N/A POSITION: N/A
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS: N/A
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S
HOUSEHOLD
NAME: DATE OF BIRTH: AGE:
JULIAH KRIXIA B. RETIZA JULY 27, 2015 5
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 the 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
Subtotal:
b. Personal Properties
DESCRIPTION YEAR ACQUIRED ACQUISITION
COST/AMOUNT
OPPO FS 1 2016 13, 000 .00
LENOVO ideapad 2020 20, 000 .00
Subtotal : 23, 000 .00
TOTAL ASSETS (a+b): 23, 000 .00
* Additional sheet/s may be used, if necessary.
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING
BALANCE
NONE NONE NONE
TOTAL LIABILITIES:
NET WORTH : Total Assets less Total Liabilities 23, 000 .00
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=
* 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 F ENTITY/BUSINESS NATURE OF BUSINESS DATE OF ACQUISITION
ENTERPRISE INTEREST &/OR FINANCIAL OF INTEREST OR
CONNECTION CONNECTION
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
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
DECEMBER 16, 2020
Date: _____________________________
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC Government Issued ID: N/A
ID No.: 128 4376 ID No.: N/A
Date Issued: SEPTEMBER 11, 2020 Date Issued: N/A
SUBSCRIBED AND SWORN to before me this _______ day of ________________affiant exhibiting to me the
above-stated government issued identification card.
HON. KATRINA JOY H. ORENCIA
Municipal Mayor
______________________________________
(Person Administering Oath)
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