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, 2020
(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: JUS JERSON A. POSITION: SSTI

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED- QUEZON NATIONAL HIGH SCHOOL

ADDRESS: SITTIO MALAKING IRRIGATION BRGY. TALIPAN OFFICE ADDRESS: M.L. TAGARAO ST. BRGY. IBABANG
PAGBILAO, QUEZON IYAM, LUCENA CITY

SPOUSE: JUS JOANA MARIE M. POSITION: SSTI

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: DEPED- QUEZON NATIONAL HIGH SCHOOL

OFFICE ADDRESS: M.L. TAGARAO ST. BRGY. IBABANG

IYAM, LUCENA CITY

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD

NAME DATE OF BIRTH AGE

YOHANN GABRIEL M. JUS JULY 08, 2009 12 Years Old
AMARAH BRYLEE M. JUS JULY 06, 2018 3 Years Old

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)

N/A N/A N/A N/A N/A N/A N/A N/A

Subtotal: N/A
b. Personal Properties*

DESCRIPTION YEAR ACQUIRED ACQUISITION

COST/AMOUNT

CLOTHES AND ACCESSORIES 2018 30,000.00

APPLIANCES AND FURNITURES 2016 34,200.00
GADGETS (LAPTOP AND CELLPHONES) 2019 54,000.00
MOTORCYCLE 2013 50,000.00
CAR (sedan) 2020 343,000.00
Subtotal : Php 511,200.00
TOTAL ASSETS (a+b): Php 511,200.00
* Additional sheet/s may be used, if necessary.

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2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

SALARY LOAN GSIS (GFAL) 500,000.00

TOTAL LIABILITIES: Php 500,000.00

NET WORTH : Total Assets less Total Liabilities = Php 11,200.00
* 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
N/A N/A N/A 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
MARICRIS J. FAJARDO SISTER TEACHER I DEPED SAN NARCISO QUEZON
CHRISTOPHER A. JUS BROTHER TEACHER I DEPED PAGBILAO QUEZON
ABEGAIL R. JUS SISTER IN LAW TEACHER I DEPED PAGBILAO QUEZON

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 9, 2022

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

Government Issued ID: PRC Government Issued ID: PRC

ID No.: 1146625 ID No.: 1199425
Date Issued: 10/09/2012 Date Issued: 05/09/2013

SUBSCRIBED AND SWORN to before me this 9TH day of F E B R U A R Y , 2 0 2 2 , affiant exhibiting to me

the above-stated government issued identification card.

JESSIE V. VASQUEZ
Principal IV

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 (Person Administering Oath)

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