Kt KHAI TAI SAN, THU NH 'AP (Ban hanh kern theo Thong twsó 08/2013/T1'-TTCP ngdy 31/10/2013 act Thanh tra Chinh phit)

NAM: 2017

I. THONG TIN CHUNG Ngueri ke khai tai san, thu nhap

- HQ va ten: VII Thi Mai Nam sixth: 1977 - CI-1(x NT/ chirc danh ding tac: Thuong true Dang ay, Truang phong TCCB - Ca quan/ don vi cong tac: B'enh vien da khoa tinh - HO khau thuang tr.& T6 3 khu 6C Phuong Hong Hai, Thanh phe Ha Long - CM 6 Men tai: SO 33 ngO 4 pho Hai LOc, Phuang Heng Hai

Vg hoac cheng cüa nguai ke khai tai san thu nhap - H9 vã ten: Nguyen Phu Nhuea'n - Chirc vu/ claim danh cong tac: Pho Giant dot e Trung tam Y te huyen Dam Ha - Co quad don vi &Ong tac: Trung tam Y ta huyen Dam Ha - Ho khau thu6ng tra: To 3 khu 6C Phtremg Hong Raiz Thanh pho Ha Long - CM Or Men tai: SO 33 ngO 4 phO Hai LOc, Phuong H8ng Hai

Con chin thanh nien caa nguai ke khai tai san thu nhap Con thu that:

- H9 va ten: Nguyen VU Nguyen Vinh - Ngay than nam sinh: 24/08/2002 - HO khau thueng trill: TO 3 khu 6C Phtrong Heng Hâi, Thanh pho Ha Long - CM 6 hien tai: SO 33 ngO 4 pho Hai LOc, Phuang H6ng Hai

Con thir hai: - H9 va ten: Nguyen Vu Nguyen laid - Ngay thang nam sinh: 17/01/2009 - HO khan thuong tra: T6 3 khu 6C Phuarng Heng Hal, Thanh ph6 Ha Long - CM eif Men tai: SO 33 ngO 4 ph6 Hal LOc, Phtftg H6ng Hai

II. THONG TIN MO TA VE TAI SAN 1. Nha Ong trinh xay duns: (Ngtreti ke khai tic ma á ccic loyi nha, cong trinh zely dwng khac do ban than, vq hoac chong, con chwa thanh nien th hutu ho (lc s& hau mOt phdn).

Nha - Nha thir 1: SO 33 ngO 4 ph6 Hai LOc, Phtrang Wing Hai, TP Ha Long + Loai nha: Rieng le Cap cling trinh: 4 + Dien tich xay dung: 350 m2 + Gia tri: 1.5 ty deng (xay dung nam 2008) + Giay chirng nhan quyan so, hat: - Nha thir 2 (tit len): Ke khai Wrung tw nhu nha thir

Cong trinh xay dung khac: - COng birth thfr 1: (Dia chi tai: + Loai cong tidy Cap cong trinh: + D*Itich xay dung: + Gia tri: + GiAy chimg than 9uyen ser ham + Thong tin lchac (neu co): - Cong trinh thu 2 (trOf. len): KO kiwi ttrang ty• nhir cong trinh thu • nhot.

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2. Quyen sir dung dat: (Istguol ke khai tie mo tá cac logi clit do ban than, vg ho'ac chang. con chi:a thgnh nien c6 guyen set dung toan 60 hoc mOt

Dat

A.

- Manh thir nhAt: + Dia chi: To 3, khu 6C, Phuang Wing Hai- TP Ha Long- tinh Quang Ninh + Dien tich: 60m2 + Gia tri: 36.000.000 &mg (mua tir nam 2001) + GiAy chirng nhan 9uyen sir dung: V 029305 - S6 490 QSDD ngay 07/5/2002 + Thong tin Ichac (neu có): - Manh thir 2: (M0 tá nhu manh thee nhitt). + Dia chi: 0 s6 5 — khu Deng Tian IT, phutmg CAm Deng, TM xA CAm Pha tinh Quang Ninh + Dien tich: 67,62m2 + Gia tri: 1.890.000 slang (mua tir 27/10/2011) + GiAy chimg nhan tiuyen sir dung: BE 571339- SO CHOO 305 ngay 17/5/2011 + Thong tin khac (neu c6):

Cac loai dAt khac: (Ghi theo ding 10, khoanh, khuon vien) - Math thir nhAt: (Ghi theo ding 10, khoanh, khuon vien). + Dia chi: + Dien tich: + Gia tri: + Giay chimg nhan ran sir dung: + Th6ng tin Ichac (nu co): - Math thir 2: (MO tá nine manh dile nhcit).

3. Tien (tin Via Nam, ngoai te) gem tin mat, tien cho vay, tin girl cac ca nhan, tó chat trong nu6c, ntrac ngoai tai Viet Nam ma tong gia tri guy dei tir 50 trieu &Ong tit len.

Teng só troll: 1.701.922.000 deng:

- Tien mat: 1.000.000.000 thing.

- Tien g• iri: 701.922 trieu deng (32.236 de la My).

4. O to, mo to, xe gait may, xe may (may Ai, may xiic, cac loai xe may khac), tau thay, tau bay, thuyen vã nhilng dena san Ichac ma Nha nu6c quart 19 (theo quy dinh dm, phap luat phai dang ki sir duns va duce cap giAy Clang ki) có tOng gia tri moi loai tir 50 triu Tong tr& len. - 0 to: 01 xe 0 to Mazda CX5 Bien ki8m soat: 14A 20329 tri gia 1.200.000 (Met 19 hai tram trieu deng) do em trai la Nguyen Huy Cithng, Giam ,doe Cong ty cO plan DAu gia Quang Ninh cho mum (xe thuOc guy& set him Cling ty CO phan ThAm dinh gia Quang Ninh) - MO to: 01 xe may Airblad tri gia 50.000.000 (ram muoi trieu &Ong)

Xe gan may - Xe may (may ii, may xitc, cac loai xe may Ichac)

Tau thity Tau bay

- Thuyen NhAng &Ong sari ichac ma NM nudge quan 19 (theo quy dinh cita phap 1u4t phai clung Ic9 sit

dung va duce cap giay tang k9)

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5. Kim loai qu3tr, cia quY, cO,phieu, vein gap vao cac co ser kinh doanh, cac loai giay to c6 gia tri chuyen nhugng khac c6 tong gia tri quy d6i mM loai tir 50 trieu thing trey len. -Kim loM qut 500 lugng yang + Ong Nguyen Huy Cueing, SO CMND: 031032061 (Giam &So C8ng ty cO phan clan gia Quang Ninh) vay 200 lugng yang. + TM san chr tic 300 lugng yang - Da quy: 01 than kim cuong tri gia 150.000.000 ang

Co phieu - Cac loai gity ta c6 gia tri chuyen nhugng khac

6. Cac loai tai san khac ma co gia tri quy d6i rn6i loai tir 50 trieu &Ong tra len (nhte coy canh, ba ban ghê, anh, do my nghe viz cac logi tài san khdc): - BO ban ghe, to: 100.000.000 ding

Sep, ban ther: 80.000.000 dong Tai, san, tai Ichoan 0 nuerc ngoai g6m Mt ca tai san quy dinh tit Khoan 1 den Khoan 6 noi

tren nam ngoai lanh th8 Viet Nam.

Cac lchoan ng Cac Ichoan phai tra, gia tri cac tai sari quan 15r he, gill he c6 t6ng gia tri tir 50 trieu dOng trer len: 7.200.000.000 thing:

+ Vay °Oa BA Pham TM Kim, SO CMND: 030054747 trii tai Quan NgO Quyen - Hai Phong so tai san la 200 lugng yang (tucmg throng 7.000.000.000 d8ng)

+ Vay Ba Trinh Thi Lan, frit tai Ti 2 khu 6 Phuerng Heing Hai, thanh ph6 Ha Long se' tin la 200.000.000 clOng (hai tram trieu thing

9; Tong thu nhap trong nam quy d6i thanh tien Viet Nam Om cac khoa'n lucmg, phçL cap, trg cap, throng, thu lao, cho, tang, bieu, thOa ke, thu nhap hueng lgi tir cac khoan dau tu, phat sinh, sang che, cac khoan thu nhap khac: 600.000.000 dang (Sau tram trieu &mg)

III. CIA! TRiNH str BIEN HONG CIJA TAI SAN, THU NHAP

Loni tai san e Tang/giam Ni dung giai trinh ngtain gtic tAi san, thu nh(ip tang them

1. Nha 0, cong trinh xay dtmg: Nha er: Clang trinh xay ding kHz:

2. Quyen sir dung clat (tang, giam ye s6 lugng, din tich, thay clOi loai dat so veri kst ke khai truerc do):

Dat 0: Cac loai elk khdc

3. Tien On Viet Nam, ngoai te) g6m ti6n mat, tien cho vay, tien giri ca nhan, to chirc trong mroc, t6 chgc nu& ngoai tai Viet Nam ma tong gia tri quy clOi tit 50 trieu &Mg tit len .

+ 61.922.000 d6n g

- Tich lily trong nam sau khi a trir cac khoan chi natl.

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Cac loai &Ong san: SO to - MO to - Xe gAn may - Xe may (may iti, cac 100 xe may khac...) - Tau thily - Tau bay - Thuyen - Nhang dOng san khac ma NM nuac guan lY (theo guy dinh dm phap luat phai dAng kY sir dung va dugc cap giay clang ky)

Cac loai tai san: -Kim loai guy - Da guy - Co phieu - V6n Op vao cat ca ser kinh doanh - Cac loai gia'y ter co gia tri chuyen nhugng khac c6 tong gia tri guy doi moi loai tir 50 trieu dong trO len

'

Cac loai tai san khac (nhu ctly canh, be ban ghe, tranh, anh, do ,n2.9 nghe va cac loci tat san khac) ma gia tri guy den mOi loai tit 50 trieu (long trey len

Tai san, tai khoan & nu& ngoai g6m Mt ca tai sari ,guy dinh tir Khoan 1 den Khoan 6 nod tren nam ngoai lanh th8 Viet Nam.

Cac khoan ng Om: the khoan phai tra, gia tri cac tAi san guan lY hO, gilt 110 c6 timg gia tri guy d8i tir 50 trieu ding trey len.

.

9., T8ng thu nhap trong nam guy MI thanh tien Viet Nam: - Luang, php cap, trg cap, thuerng, thii lao dm 2 vg ch6ng: 600 trieu d6ng;

- 600 trieu ding

- Thu nhap tang them nam 2017 dm vg film so veri Warn 2016; - Rat von tir cong ty.

(Ngwol ké khai tv xcic dinh cac logi tai san tang giam trong k) ke khai va gicii trinh sit tang, giam curl tat san thuac so• Idea cua ban than, vg hoc thong, con chtea thanh Men).

Ngay nh an ban ke khai tai san, thu nh'ap Ngay thang .4i. nam As.ttier

Ngtrbi nhan ban ke khai (K), ghl r5 ho ten, chat va/chat danh)

/Y- v Trot

ferpoi Otte: 141

Wry holm thanh ban ke khai tai sent thu nhap Ngay de?.. thang nam 2017 Nguti ke khai tii sin, thu nhip

ofit

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