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 31, 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: PUERTO, LIEZEL B. POSITION: Teacher II
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DepEd/ Mabini NHS
OFFICE ADDRESS: Brgy. Mabini, Escalante City,
ADDRESS: Brgy. Bulanon, Sagay City, Negros Occidental, Philippines
Negros Occidental, Philippines, 6124
SPOUSE: Puerto, Leonard Jr. D. POSITION: N/A
(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
Puerto, Lj B. August 25, 2018 2
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 ASSESSED CURRENT FAIR ACQUISITION
VALUE MARKET VALUE
EXACT ACQUISITION
LOCATION COST
(e.g. lot, house and lot, (e.g., residential, commercial, (As found in the Tax Declaration
condominium, and industrial, agricultural and mixed
of Real Property) YEAR MODE
improvements) used)
Brgy. Bulanon,
House Residential Sagay City 2018 Cash 100,000
House Improvement Residential Brgy. Bulanon, 2019 Cash 100,000.00
Sagay City
House Improvement Residential Brgy. Bulanon, 2020 Cash 100,000.00
Sagay City
Subtotal: 300,000.00
b. Personal Properties*
DESCRIPTION YEAR ACQUISITION COST/AMOUNT
ACQUIRED
Multicab 2017 165,000.00
Motorcycle (XRM 125 FI) 2018 88,634.00
Cash in Bank 2020 90,000.00
Subtotal: 343,634.00
TOTAL ASSETS (a+b): 643,634.00
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Salary Loan CSB 1,555.00
Personal Loan Annaliza M. Biñas 3,000.00
TOTAL LIABILITIES: 4,555.00
* Additional sheet/s may be used, if necessary. NET WORTH: Total Assets less Total Liabilities = 639,079.00
Page 2 of 2
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
ENTITY/BUSINESS INTEREST & / OR OF INTEREST OR
ENTERPRISE FINANCIAL CONNECTION
CONNECTION
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
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: January 21, 2021
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC License Government Issued ID:
ID No: 1244150 ID No.:
Date Issued: 01,06,2020 Date Issued:
SUBSCRIBED AND SWORN to before me this _______ day of ____________________ , affiant exhibiting to me the above-stated
government issued identification card.
(Person Administering Oath)
Page 2 of 2
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
(Sample additional sheet/s for the exclusive properties of the declarant's spouse and unmarried children
below eighteen (18) years of age living in declarant's household)
NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
ASSETS, LIABILITIES AND NETWORTH
1. ASSETS
a. Real Properties
ASSESSED CURRENT FAIR
DESCRIPTION KIND ACQUISITION
VALUE MARKET VALUE
(e.g., residential,
EXACT ACQUISITION COST
(e.g. lot, house and lot, LOCATION
commercial, industrial, (As found in the Tax Declaration of Real
condominium, and
agricultural and mixed Property) YEAR MODE
improvements)
used)
b. Personal Properties
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT
2. LIABILITIES
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST & DATE OF ACQUISITION OF
ENTERPRISE / OR FINANCIAL CONNECTION INTEREST OR CONNECTION
Page _____ of ______
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
(Sample additional sheet/s for the declarant)
NAME: POSITION:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE:
ASSETS, LIABILITIES AND NETWORTH
1. ASSETS
a. Real Properties
DESCRIPTION KIND ASSESSED CURRENT FAIR ACQUISITION
VALUE MARKET VALUE
EXACT
(e.g., residential, ACQUISITION COST
(e.g. lot, house and lot, commercial, industrial, LOCATION (As found in the Tax Declaration of Real
condominium, and agricultural and mixed Property) YEAR MODE
improvements) used)
Subtotal: -
b. Personal Properties
DESCRIPTION YEAR ACQUIRED ACQUISITION COST/AMOUNT
Subtotal: -
TOTAL ASSETS (a+b): -
2. LIABILITIES
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
TOTAL LIABILITIES: -
BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS INTEREST & DATE OF ACQUISITION OF
ENTERPRISE / OR FINANCIAL CONNECTION INTEREST OR CONNECTION
Page _____ of ______
