### St. Francis Xavier High School of Lopez Jaena, Inc.

Lopez Jaena, Misamis Occidental, 7208

REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED PROPERTY

Entity Name : SFXHS LOPEZ JAENA,INC. Fund Cluster: ______________

Department/Office: Elementary , Junior High School, Senior High School Request No. : 1
Accountable Officer: SFXHS Date : __________
Designation :
Status of Property : (check applicable box)
Lost Damaged /
Stolen 0 Destroyed /

Property No. Description Acquisition Cost

Section
JHS202307 SLR New Wooden Chairs with Armpad (7)
SLR Ceiling Fan ( 2)
JHS202308 St. Luke New Wooden Chairs with Armpad ( 2)
St. Luke Ceiling Fan ( 1)
JHS202310 St. Mark Wall Fan (1)
JHS202312 St. Therese Orbit Fan ( 1)
St. Therese Old Wooden Armed Chair ( 1)
JHS202315 St. Vincent Old Wooden Chairs with Armpad (1)
St. Vincent Light Bulb (1)
JHS202316 St. John Old Wooden Chairs with Armpad (5)
JHS202317 LOL Old Wooden Chairs with Armpad (1)
Old Wooden Teacher Table ( 1)
JHS202321 St. Gabriel Wall Fan (1)
ES202301 Kinder Ceiling Fan ( 2)
Comp. Lab. Airconditioner ( 1)

Notes:

Need to Repair for the preparation of the S.Y 2023-2024.

Prepared by:
JOAN G. OBSIOMA
School Property Custodian Approved by:
ELEONORA C. DIGAMON
School Principal

Before the declaration of the quarantine period, the said speaker was
I hereby certify that the item/s and circumstances stated above are true and correct. Before the declaration of the quarantine period, the said speaker was
Signature
Noted by: Before the declaration of the quarantine period, the said speaker was
over Printed computer room and the speaker is still there. Come June, 2022, Sir Ph
Name of the
School coordinator and during the transition, I noticed that the speaker was alr
Signature over Printed Name Property
Custodian coordinator and during the transition, I noticed that the speaker was alr
________________________________ _________________________
Date of Monitoring Date of Monitoring

Government Issued ID:

ID No.:
Date Issued:

SUBSCRIBED AND SWORN to before me this _________ day of ____________________, affiant exhibiting
the above government issued identification card.

Doc. No. _______

Page No. _______ __________________________
Book No. _______ Notary Public
Series of _______

184
### St. Francis Xavier High School of Lopez Jaena, Inc.
Lopez Jaena, Misamis Occidental, 7208

REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED PROPERTY

Entity Name : SFXHS LOPEZ JAENA,INC. Fund Cluster: ______________

Department/Office: Elementary and Junior High School RLSDDP No. : _____________
Accountable Officer: RLSDDP Date : __________
Designation :
Status of Property : (check applicable box)
Lost Damaged /
Stolen 0 Destroyed /

Property No. Description Acquisition Cost

JHS202307 ( SLR) New Wooden Chairs with Armpad (7)
JHS202308 ( Luke) New Wooden Chairs with Armpad ( 2)
JHS202315 Old Wooden Chairs with Armpad (1)
JHS202316 Old Wooden Chairs with Armpad (5)
JHS202317 Old Wooden Chairs with Armpad (1)
JHS202308 Ceiling Fan ( 1)
JHS202321 Wall Fan (1)
JHS202315 Light Bulb (1)
ES202301 Ceiling Fan ( 2)
Comp. Lab. Airconditioner ( 1)
JHS202312 Students Table ( 1)

Notes: Need to Repair

Prepared by:
JOAN G. OBSIOMA
School Property Custodian Approved by:
ELEONORA C. DIGAMON
School Principal

Before the declaration of the quarantine period, the said speaker was
I hereby certify that the item/s and circumstances stated above are true Before the declaration of the quarantine period, the said speaker was
and correct. Signature
Noted by: Before the declaration of the quarantine period, the said speaker was
over Printed computer room and the speaker is still there. Come June, 2022, Sir Ph
Name of the
School coordinator and during the transition, I noticed that the speaker was al
Signature over Printed Name Property
Custodian coordinator and during the transition, I noticed that the speaker was al
________________________________ _________________________
Date of Monitoring Date of Monitoring

Government Issued ID:

ID No.:
Date Issued:

SUBSCRIBED AND SWORN to before me this _________ day of ____________________, affiant exhibiting
the above government issued identification card.

Doc. No. _______

Page No. _______ __________________________
Book No. _______ Notary Public
Series of _______

184
### Appendix 75

REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED PROPERTY

Entity Name : Fund Cluster: ______________

Department/Office: RLSDDP No. : _____________
Accountable Officer : RLSDDP Date : __________
Designation :
Status of Property : (check applicable box)
Lost Damaged
Stolen Destroyed

Property No. Description Acquisition Cost

Circumstances:

Before the declaration of the quarantine period, the said speaker was
I hereby certify that the item/s and circumstances stated above are true key to the said room was in my custody and the duplicate was with our
and correct. Signature
Noted by: access. In between that period the ICT monitoring team came and check
over Printed computer room and the speaker is still there. Come June, 2022, Sir Ph
Name of the
School coordinator and during the transition, I noticed that the speaker was alr
Signature over Printed Name of the Teacher Property
Custodian
________________________________ _________________________
Date of Monitoring Date of Monitoring

Government Issued ID:

ID No.:
Date Issued:

SUBSCRIBED AND SWORN to before me this _________ day of ____________________, affiant exhibiting
the above government issued identification card.

Doc. No. _______

Page No. _______ __________________________
Book No. _______ Notary Public
Series of _______

184