Attachment 11

SWORN STATEMENT INDEX NO._________

SWORN STATEMENT OF THE TRUE CURRENT AND MARKET VALUE OF REAL PROPERTIES
(Taxable or Exempt)
(Required under Section 202/203 of Republic Act. No.7160)

I, ____________________________________, of legal age, _________________________________________ and with postal address at ______________________________________,

(Citizenship) (Civil Status)

after having been duly sworn to in accordance with law hereby depose and say:

1. That I am the ____________________________________ of the following real properties, (lands, buildings, machineries or other improvements) located in the city of Davao owned by
(Owner or Administrator or Authorized Representative)

______________________________________________________ of which the description and true current and fair market value/s are as follows:
(State Name of Owner/s if filed by administrative or authorized representative)

A. LAND (Residential, Commercial, Industrial, Agricultural, Special)

Lot Block Cadastral/ PLS Classification Location of Property Total Current and Fair
Existing Tax Dec. No. Title Area Ha./Sq.M
No. No. No. (Res.,Agr.,Com.,etc. (St./Dist./Barangay) Market Value

B. BUILDING AND OTHER STRUCTURES

Total Year
No. General Actual Owner of Lot Where Bldg. Is Location of Property Total Current and Fair
Existing Tax Dec. No. Floor Area Completed/
Storey Description Use Located (No./St./Dist./Barangay) Market Value
in (Sq.M.) Occupied
C. MACHINERIES

Date Original Location of

True Current and Fair Market
Existing Tax Dec. No. Description Acquisition Cost of Installation on Site Value of Depreciation Property
Commenced Value
Acquired Cost (St./Dist./Barangay)
Operation

OTHER IMPROVEMENTS (Perennial Trees/Plants)

Kinds of Trees/ No. of Trees/ Annual Product per True Current and Fair Market Value
Existing Tax Dec. No. No. of Trees/ Hec. & Ages Non-Productive
Plants Hec./ Productive Tree/Plant
Productive Non-Productive

2. That I am executing this sworn statement in compliance with Republic Act No. 7160

IN WITNESS WHEREOF, I Have hereunto affixed my signature this _______day of _________________, ________at________________________ if thumbmarks require signatures of two (2)
witnesses.

______________________ ________________________ ______________________________

(Witness) (Witness) Signature
SUBSCRIBE AND SWORN to before me this ______day of_____________, 20___, affiant exhibiting his/her Community Tax Certificate No. A-_______________Issued on
__________________at______________________, Philippines.
______________________________
(signature of Administering Officer

TIN____________________________
NOTE:
1) Include in this sworn statement only real property owned or administered by the affiant in one municipality or city.
2) Prepare three (3) copies and after having been subscribed to by the affiant, submit the same to the Provincial, City, Municipal Assessor or Municipal Deputy Assessor or Ex-Officio Deputy Assessor of the province, city or
municipality where the property is located; the original and duplicate to be retained by receiving office and the triplicate to be returned to the affiant after receipt thereof has been duly acknowledge.
3) Write “NEW” under column “Existing Tax Dec. No.” for property not previously declared.
4) Original acquisition cost of Machinery.