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Joint Filing
DECLARANT
Separate Filing
Pirote
Avaglez
C.
(Family Name)
(First Name)
(M.I.)
Not Applicable
Administrative Assistant III
POSITION:
:
ADDRESS:
AGENCY/OFFICE:
DEPED-CSDT
OFFICE ADDRESS:
Tacurong City,SK
SPOUSE:
Sultan Kudarat
Pirote
Kelvin Roy
(Family Name)
(First Name)
J.
N/A
POSITION:
(M.I.)
AGENCY/OFFICE:
OFFICE ADDRESS:
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD
NAME
DATE OF BIRTH
AGE
7
1
Real Properties*
DESCRIPTION
KIND
EXACT
ASSESSED
CURRENT FAIR
(e.g. residential,
commercial, industrial,
agricultural and mixed
use)
LOCATION
VALUE
MARKET VALUE
300 sq
meters
Residential
Brgy. Tina,
Tacurong City
ACQUISITION
ACQUISITION
COST
YEAR
MODE
2011
Inst.
P150,000.000
Subtotal:
b. Personal Properties*
DESCRIPTION
YEAR ACQUIRED
ACQUISITION
COST/AMOUNT
2011
P30,000.00
Subtotal : P180,000.00
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2. LIABILITIES*
NATURE
NAME OF CREDITORS
OUTSTANDING BALANCE
P80,000.00
P8,500.00
BUSINESS ADDRESS
NATURE OF BUSINESS
INTEREST &/OR FINANCIAL
CONNECTION
DATE OF ACQUISITION OF
INTEREST OR CONNECTION
RELATIONSHIP
POSITION
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 aboveenumerated 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)
Government Issued ID:
ID No.:
Date Issued:
(Signature of Co-Declarant/Spouse)
Government Issued ID:
ID No.:
Date Issued:
Page 3 of ___
day of
_______________________________________
(Person Administering Oath)
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