ࡱ> _ bjbj 4bbS[VVR0www}$4Biwwwww !!!wR}!w}!!! 6"!i"0R!vXv!v!Hww!wwwww!wwwRwwwwvwwwwwwwwwV v: S Y T TNH LM NG TRUNG TM Y T HUYN LM H -------CNG HA X HI CH NGH(A VIT NAM c lp - T do - Hnh phc --------------- BN K KHAI TI SN, THU NHP HNG NM (NM 2023) (Ngy..... thng 11 nm 2023 ) I. THNG TIN CHUNG 1. Ngi k khai ti sn, thu nhp - H v tn:........................................................ Ngy thng nm sinh: ............................... - Chc v/chc danh cng tc: ............................................................................................ - C quan/n v cng tc: ................................................................................................... - Ni thng tr: ................................................................................................................... - S cn cc cng dn hoc giy chng minh nhn dn(3): ..........................................ngy cp.............................. ni cp .......................................... 2. V hoc chng ca ngi k khai ti sn, thu nhp - H v tn:...................................................................... Ngy thng nm sinh: ................. - Ngh nghip: ...................................................................................................................... - Ni lm vic(4): .................................................................................................................... - Ni thng tr: ................................................................................................................... - S cn cc cng dn hoc giy chng minh nhn dn: .......................................................... ngy cp................................... ni cp ............................................... 3. Con cha thnh nin (con , con nui theo quy nh ca php lut) 3.1. Con th nht: - H v tn:.............................................................. Ngy thng nm sinh: .......................... - Ni thng tr: .................................................................................................................... - S cn cc cng dn hoc giy chng minh nhn dn: ............................................................ ngy cp.............................................. ni cp .............................................. 3.2. Con th hai (tr ln): K khai tng t nh con th nht. II. THNG TIN M T V TI SN(5) 1. Quyn s dng thc t i vi t(6): 1.1. t (7): 1.1.1. Tha th nht: - a ch(8): .............................................................................................................................. - Din tch(9): ........................................................................................................................... - Gi tr(10): .............................................................................................................................. - Giy chng nhn quyn s dng(11): ................................................................................... - Thng tin khc (nu c)(12): .................................................................................................. 1.1.2. Tha th 2 (tr ln): K khai tng t nh tha th nht. 1.2. Cc loi t khc(13): 1.2.1. Tha th nht: - Loi t:................................ a ch: .................................................................................. - Din tch: .............................................................................................................................. - Gi tr(10): ............................................................................................................................. - Giy chng nhn quyn s dng: ...................................................................................... - Thng tin khc (nu c): ..................................................................................................... 1.2.2. Tha th 2 (tr ln): K khai tng t nh tha th nht. 2. Nh , cng trnh xy dng: 2.1. Nh : 2.1.1. Nh th nht: ............................................................................................................... - a ch: ................................................................................................................................. - Loi nh(14): .......................................................................................................................... - Din tch s dng (15): .......................................................................................................... - Gi tr(10): .............................................................................................................................. - Giy chng nhn quyn s hu: ......................................................................................... - Thng tin khc (nu c): ...................................................................................................... 2.1.2. Nh th 2 (tr ln): K khai tng t nh nh th nht. 2.2. Cng trnh xy dng khc(16): 2.2.1. Cng trnh th nht: - Tn cng trnh:........................................ a ch: ............................................................... - Loi cng trnh:............................................ Cp cng trnh: .............................................. - Din tch: ............................................................................................................................. - Gi tr (10): ............................................................................................................................. - Giy chng nhn quyn s hu: ......................................................................................... - Thng tin khc (nu c): ...................................................................................................... 2.2.2. Cng trnh th 2 (tr ln): K khai tng t nh cng trnh th nht. 3. Ti sn khc gn lin vi t(17): 3.1. Cy lu nm(18): - Loi cy:.................................. S lng:........................... Gi tr(10): .................................. - Loi cy:.................................. S lng:........................... Gi tr(10): .................................. 3.2. Rng sn xut(19): - Loi rng:.......................................... Din tch:................................. Gi tr(10): ................... - Loi rng:.......................................... Din tch:................................. Gi tr(10): ................... 3.3. Vt kin trc khc gn lin vi t: - Tn gi:.................................... S lng:............................. Gi tr(10): ................................ - Tn gi:.................................... S lng:............................. Gi tr(10): ................................ 4. Vng, kim cng, bch kim v cc kim loi qu,  qu khc c tng gi tr t 50 triu ng tr ln(20). 5. Tin (tin Vit Nam, ngoi t) gm tin mt, tin cho vay, tin tr trc, tin gi c nhn, t chc trong nc, t chc nc ngoi ti Vit Nam m tng gi tr quy i t 50 triu ng tr ln(21). 6. C phiu, tri phiu, vn gp, cc loi giy t c gi khc m tng gi tr t 50 triu ng tr ln (khai theo tng loi): 6.1. C phiu: - Tn c phiu:............................................ S lng:.......................... Gi tr: ....................... - Tn c phiu:............................................ S lng:.......................... Gi tr: ....................... 6.2. Tri phiu: - Tn tri phiu:........................................... S lng:........................... Gi tr: ...................... - Tn tri phiu:........................................... S lng:........................... Gi tr: ...................... 6.3. Vn gp(22): - Hnh thc gp vn:......................................................... Gi tr:............................................. - Hnh thc gp vn:......................................................... Gi tr:............................................. 6.4. Cc loi giy t c gi khc(23): - Tn giy t c gi: ............................................................ Gi tr:.......................................... - Tn giy t c gi:............................................................. Gi tr:.......................................... 7. Ti sn khc m mi ti sn c gi tr t 50 triu ng tr ln, bao gm: 7.1. Ti sn theo quy nh ca php lut phi ng k s dng v c cp giy ng k (tu bay, tu thy, thuyn, my i, my xc, t, m t, xe gn my...)(24): - Tn ti sn:................................... S ng k:................................ Gi tr: .......................... - Tn ti sn:................................... S ng k:................................ Gi tr: .......................... 7.2. Ti sn khc ( m ngh,  th cng, bn gh, cy cnh, tranh, nh, cc loi ti sn khc)(25): - Tn ti sn:................................. Nm bt u s hu:.......................... Gi tr: ................... - Tn ti sn:................................. Nm bt u s hu:.......................... Gi tr: ................... 8. Ti sn  nc ngoi(26). 9. Ti khon  nc ngoi(27): - Tn ch ti khon: ....................................................., s ti khon: ..................................... - Tn ngn hng, chi nhnh ngn hng, t chc ni m ti khon: ........................................ 10. Tng thu nhp gia hai ln k khai(28): - Tng thu nhp ca ngi k khai: ......................................................................................... - Tng thu nhp ca v (hoc chng): ..................................................................................... - Tng thu nhp ca con cha thnh nin: .............................................................................. - Tng cc khon thu nhp chung: .......................................................................................... III. BIN NG TI SN, THU NHP; GII TRNH NGUN GC CA TI SN, THU NHP TNG THM (29) (nu l k khai ti sn, thu nhp ln u th khng phi k khai Mc ny): .......... Loi ti sn, thu nhpTng (30)/gim (31)Ni dung gii trnh ngun gc ca ti sn tng thm v tng thu nhpS lng ti snGi tr ti sn, thu nhp1. Quyn s dng thc t i vi t 1.1. t  1.2. Cc loi t khc 2. Nh , cng trnh xy dng 2.1. Nh  2.2. Cng trnh xy dng khc 3. Ti sn khc gn lin vi t 3.1. Cy lu nm, rng sn xut 3.2. Vt kin trc gn lin vi t 4. Vng, kim cng, bch kim v cc kim loi qu,  qu khc c tng gi tr t 50 triu ng tr ln 5. Tin (tin Vit Nam, ngoi t) gm tin mt, tin cho vay, tin tr trc, tin gi c nhn, t chc trong nc, t chc nc ngoi ti Vit Nam m tng gi tr quy i t 50 triu ng tr ln. 6. C phiu, tri phiu, vn gp, cc loi giy t c gi khc m tng gi tr t 50 triu ng tr ln (khai theo tng loi): 6.1. C phiu 6.2. Tri phiu 6.3. Vn gp 6.4. Cc loi giy t c gi khc 7. Ti sn khc c gi tr t 50 triu ng tr ln: 7.1. Ti sn theo quy nh ca php lut phi ng k s dng v c cp giy ng k (tu bay, tu thy, thuyn, my i, my xc, t, m t, xe gn my...). 7.2. Ti sn khc ( m ngh,  th cng, bn gh, cy cnh, tranh nh, cc loi ti sn khc). 8. Ti sn  nc ngoi. 9. Tng thu nhp gia hai ln k khai(32).Lm H, ngy thng 11 nm 2023 NGI NHN BN K KHAI (K, ghi r h tn, chc v/chc danh)Lm H, ngy ,brt  V "HNfl(0  !!$$ **4+<+(,0,//R3Z3,747X7`78 89&999t:|:|;;<<==>>t@|@EE@Hh5H*\ hH* hHU5\hi~h5CJ\aJh h5\ hi~5\ hi~\hi~hi~\K,t   ( ^TGTT $x\$a$gd x\$gdkd$$If0V$+  t0622 l4apyti~$$-DIfM a$gdm(    Rxn|>Rp b! $x\$a$gdI2 x\$gdb!!!"#%%&|'''() +,2-&.*///&0,1(2>3Z4N5R6687 x\$gd87d7j8p99:;< =>>@~AABCCDEEFGNHZIfJKJLNM $x\$a$gdI2 x\$gd@HHH>LFLOO:QBQxQQSSSSW6X>X@XXXYY$Y,Y8Y@YBYYYYY$ZbbcFcLcVcXccccdz$z&zRzxzzzzzzzh{{|D|||:}ǾhI2hI2CJ\aJhm5CJ\aJhmhI25CJ\aJhI2CJ\aJ *hHU5CJ\aJU hI26] h6]h5H*\ h5\hHUh hH*|8:Z2X6tnpX~ 8:LN(jlɻɷɷɷɷɷɷɷɷɷ hYhfVP hH*hhI2h5CJ\aJ h5\hI25CJ\aJ *hHUhHU5CJ\aJhI2hI2CJ\aJhI2CJ\aJChځ:\2Z6vX>X.ئ* x\$gdxgdI2 $xa$gdI2T8ƱZZ :N $$Ifa$gd x\$gd*,K???? $$Ifa$gdkdT$$If4F $    t0    24apyt,.ZpZQQQQQQ $Ifgdkd$$If4\ $   t24ap(yt$\nULLLLLLL $Ifgdkd$$If\ $   t(24ap(yt ULLLL $Ifgdkd$$If\ $   t(24ap(ytULLLL $Ifgdkd $$If\ $   t(24ap(yt(ULLLLL $Ifgdkd. $$If\ $   t(24ap(yt(*ULLLL $IfgdkdQ $$If\ $   t(24ap(yt4pzULLLLLL $Ifgdkdt $$If\ $   t(24ap(yt $ULLLL $Ifgdkd$$If\ $   t(24ap(yt$&rvRULLLLLL $Ifgdkd$$If\ $   t(24ap(ytUK x\$gdI2kd$$If\ $   t(24ap(yt21h:pU Q/ =!"n#n$n% $$IfV!vh#v+#v :V t065+5 / ?22 l4 apyti~K$$If!vh#v#v. #v :V 4  t063+,55X5/ $$If!vh#v#v #v :V 4  t0+,55 5 / 6666666666666666666666666666666666666666666666666hH666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~PJ_HmH nH sH tH D`D NormalCJPJ_HaJmH sH tH DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List B^@B Y Normal (Web)dd[$\$FoF YNormal (Web) Char CJPJaJDOD YChar4 dCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] S[@H:}27l( b!87NMY(Z[czzh,($345689:;<kmnopqrstuvwxy8@0(  B S  ?B.N.22220303i3i3{3X5U[B.N.22220303i3i3{3X5R[U[  I2fVPU QHUyi~.Wm%YS[U[@V$d .S[$,4>zUnknownG*Ax Times New Roman5Symbol3. *Cx Arial7.@ CalibriA$BCambria Math"1h[G[G M . M .!nd0%[%[KqHP  $P2!xx ThienITAdminOh+'0 px  ThienITNormalAdmin2Microsoft Office Word@F#@24"@24"  M՜.+,0 hp   Microsoft.%[  Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz|}~Root Entry F@6"Data {,1TablevWordDocument4SummaryInformation(DocumentSummaryInformation8CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q