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 2016
(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 CORTEZ JHOANNA G POSITION: MASTER TEACHER 1

:
(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED/DIVISION OF CSFP
ADDRESS: #3017 PUROK 11 AUREA SUBD. OFFICE ADDRESS: CITY OF SAN FERNANDO,
STA LUCIA CSFP PAMPANGA

SPOUSE: CORTEZ JANER R POSITION: POLICE SENIOR INSPECTOR

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: PNP/RPSB3
OFFICE ADDRESS: CAMP OLIVAS

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANTS HOUSEHOLD

NAME DATE OF BIRTH AGE

VALERIE JOYCE G. CORTEZ FEB. 11, 2004 12
JAN ERWIN G. CORTEZ JAN. 9, 2009 8
JANER G. CORTEZ JR. JAN. 24, 2010 7

ASSETS, LIABILITIES AND NETWORTH

(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarants 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
Real Property)
use)

LOT RESIDENTIAL #3017 Purok 11 Aurea 300,000 250,000 2004 Inheritance 10,000.00
Subdivision Sta Lucia,
CSFP

House RESIDENTIAL #3017 Purok 11 Aurea 850,000 1,000,000 2004 Purchased 500,000
Subdivision Sta Lucia,
CSFP

Subtotal: 510,000
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

TOYOTA ADVENTURE 2015 300,000

YAMAHA FZ16 2014 70,000
APPLIANCES AND FURNITURE 2004 TO PRESENT 200,000
CASH ON HAND PRESENT 50,000
Subtotal : 620,000
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 TOTAL ASSETS (a+b): 1,130,000
* Additional sheet/s may be used, if necessary.

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN AFPSLAI 200,000

TOTAL LIABILITIES: 200,000

NET WORTH : Total Assets less Total Liabilities = 930,000
* Additional sheet/s may be used, if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant /Declarants spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarants 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

N/A

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

JENNILYN PRADO SISTER PSI PNP, CAMP CRAME QUEZON CITY

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: ____January 12, 2017

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

Government Issued ID: PRC Government Issued ID: PNP ID

ID No.: 0718058 ID No.: 15HO60132
Date Issued: NOV. 5, 2001 Date Issued: AUG. 6, 2015

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

_______________________________________
(Person Administering Oath)

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