Saln Form 2015

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, 2022
(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: MIDAY DHIL MARRY S. POSITION: TEACHER-1

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED-DIVISION OF CAMARINES SUR
ADDRESS: ZONE 7, FABRICA,
BULA, CAMARINES SUR OFFICE ADDRESS: SAN JOSE, PILI, CAMARINES SUR
SPOUSE: MIDAY SALUSTIANO H. POSITION: SELF EMPLOYED

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: NONE
OFFICE ADDRESS: NONE
UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD
NAME DATE OF BIRTH AGE

SACHARY MARL S. MIDAY MARCH 17, 2019 3
STEPHEN MARKY S. MIDAY MAY 14, 2021 1
Nothing follows Nothing follows Nothing follows
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 ZONE 7, FABRICA, BULA, 240,000 280,000 2020 PURCHASED 240,000
CAMARINES SUR
LOT RESIDENTIAL ZONE 7, FABRICA, BULA, 80,0000 150,000 2020 INHERITED 0

CAMARINES SUR
-Nothing Follows -Nothing Follows -Nothing Follows -Nothing -Nothing Follows -Nothing -Nothing -Nothing Follows
Follows Follows Follows
Subtotal: 240,000
b. Personal Properties*
DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT
Cellphone/Laptop 2022 37,000

Motorcycle 2022 15,000
Subtotal : 52,000
TOTAL ASSETS (a+b): 292, 000

* Additional sheet/s may be used, if necessary.
Page 1 of 2
2. LIABILITIES*
NATURE NAME OF CREDITORS OUTSTANDING BALANCE
Salary Loan Producers Bank 60,000

TOTAL LIABILITIES: 60,000

NET WORTH : Total Assets less Total Liabilities = 232,000
* 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
NONE NONE NONE NONE
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
CHRIZEL R. IBASCO COUSIN Teacher 1 DepEd SDO Camarines Sur
CLEMENCIA H. MIDAY SISTER-IN-LAW Teacher 1 DepEd SDO Camarines Sur
Nothing follows Nothing follows Nothing follows Nothing follows
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: February 15, 2023
(Signature of Declarant) (Signature of Co-Declarant/Spouse)
Government Issued ID: PRC ID Government Issued ID: DRIVER’S LICENSE

ID No.: 1415824 ID No.: N26-15-033650
Date Issued: 12/21/2015 Date Issued: 8/18/2019
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

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Revised as of January 2015

Per CSC Resolution No. 1500088

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

DECLARANT: MIDAY DHIL MARRY S. POSITION: TEACHER-1

SPOUSE: MIDAY SALUSTIANO H. POSITION: SELF EMPLOYED

NAME DATE OF BIRTH AGE

ASSETS, LIABILITIES AND NETWORTH

DESCRIPTION KIND EXACT ASSESSED CURRENT FAIR ACQUISITION ACQUISITION

LOT RESIDENTIAL ZONE 7, FABRICA, BULA, 80,0000 150,000 2020 INHERITED 0

DESCRIPTION YEAR ACQUIRED ACQUISITION

Cellphone/Laptop 2022 37,000

TOTAL ASSETS (a+b): 292, 000

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

Salary Loan Producers Bank 60,000

TOTAL LIABILITIES: 60,000

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

 I/We do not have any business interest or financial connection.

NAME OF ENTITY/BUSINESS BUSINESS ADDRESS NATURE OF BUSINESS DATE OF ACQUISITION OF

RELATIVES IN THE GOVERNMENT SERVICE

 I/We do not know of any relative/s in the government service)

Date: February 15, 2023

(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued ID: PRC ID Government Issued ID: DRIVER’S LICENSE

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