(Form 1) SWORN STATEMENT OF ASSETS & LIABILITIES AND NETWORTH1994 DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

AND IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICEAs of December 31, 2009

(Required by R.A. No. 6713)

DIAZ JONATHAN D Position/Income: Teacher III/P16,101 Surname First Name M.I. Office: DAAN SARILE ELEMENTARY SCHOOLAddress: 278 PANTOC II, DAAN SARILE, Office Address: DAAN SARILE CABANATUAN CITY CABANATUAN CITY

Spouse Name: DIAZ MARITES B Position: TEACHER I Surname First Name M.I. Office: NUEVA ECIJA HIGH SCHOOL

Unmarried children below 18 years of age: Name Date of Birth

SIGMUND JOHN B. DIAZ JULY 23, 1995TYRONE JOHN B. DIAZ MARCH 15, 1997BRANDON JOHN B. DIAZ MARCH 07, 1998

A. ASSETS, LIABILITIES AND NETWORTH

1. ASSETS

a. Real Properties

KIND LOCATION YEAR ACQUIRED

MODE OF ACQUISITION

NATURE OF PROPERTY (paraphernal, conjugal, or community)

ASSESSED VALUE

CURRENT FAIR

MARKET VALUE

ACQUISITION COST

Land, Building, etc. Improvements

RESIDENTIAL LOT

DAAN SARILE, CABANATUAN

CITY2008 INHERITANCE CONJUGAL P3,600 P100,000

HOUSEDAAN SARILE, CABANATUAN

CITY2008 PURCHASED CONJUGAL P70,000 P70,000

MOTORCYCLE WITH SIDECAR 2006 INSTALLMENT P50,000 P50,000

Total P 220,000

b. Personal and Other Properties

KIND/S YEAR ACQUIRED ACQUISITION COST

JEWELRIES 2006-PRESENT P10,000APPLIANCES 2006-PRESENT P50,000

Total P 60,000 2. LIABILITIES (Loans, mortgages, etc.)

NATURE NAME OF CREDITORS AMOUNT

CONSO-LOAN GSIS P120,000MULTI-PURPOSE LOAN PAG-IBIG P60,000

Total P 180,000

NETWORTH [Total Assets (1a + 1b) less Total Liabilities (2)] Total P 100,000 Note; Please use additional forms/sheets if necessary.

B. BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

Do you have any business interest and other financial connections including those of your spouse and unmarried children below 18 years of age living with you in your household? Yes No If yes, give particulars:

NAME NAME OF FIRM/COMPANY ADDRESS

NATURE OF BUSINESS INTEREST

&/OR FINANCIAL CONNECTIONS

DATE OF ACQUISITION

OR CONNECTION

B. IDENTIFICATION OF RELATIVES IN THE GOVERNMENT SERVICE

To the best of your knowledge, are you related within the fourth degree of consanguinity or affinity to anyone working in the government? YES NO If yes, give particulars:

NAME POSITION RELATIONSHIP NAME/ADDRESS OF OFFICE

MARITES B. DIAZ TEACHER I SPOUSE NUEVA ECIJA HIGH SCHOOLCABANATUAN CITY

I hereby certify to the best of my knowledge and information, that these are true statements of my assets, liabilities, networth, business interest and financial connections including those of my spouse and unmarried children below 18 years of age and names of relatives in the governments as of December 31, 2009, as required by and in accordance with Republic Act 6713.

I hereby authorize the Ombudsman or his authorized representatives to obtain and secure from all appropriate government agencies, including the Bureau of Internal Revenue, such documents that may show my assets, liabilities, networth, 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 the government.

Date: APRIL 09, 2010

Signature of Spouse Signature

TIN: 239 533 597 TIN: 912 289 109

Com. Cert. No. 33328178 Com. Cert. No. 27896982 Issued at: CABANATUAN CITY Issued at: CABANATUAN CITYIssued on: APRIL 06, 2010 Issued on: January 27, 2010