icE KHAI TAI SAN, THU NHAP (Ban hanh kern theo Thing tre 08/2013/TT-TTCP ngay 31/10/2013 cira Thanh tra Chinh pher)

NAM: 2017

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

- HQ va ten: Nguyen Huy Tien Nam sinh: 1974 - Chirc vu/ chat danh cong tac: Bac si chuyen khoa II/ PM giam dac - Ca quan/ dcrn vi tong tac: Benh vin Da khoa tinh Quang Ninh - Ho khau thuang tra: T6 4 khu 3, phuang Hong Ha, Tp. Ha Long, tinh Quang Ninh - Ch8 & hien tai: To 4 khu 3, phuang Hong Ha, Tp. Ha Long, tinh Quang Ninh

Vg hoac thong caa ngtrOi ke khai tai san thu nhap - Ho vã ten: Tran Thi Ngoc Anh Nam sinh: 1978 - Chat vo/ chat danh ciang tac: PhO phang hanh chinh - Ca quan/ dcm vi c6ng tac: Trung tam bao try tre em ca hoan canh dc biet drib Quang Ninh.

HO lchau thuang au: T6 4 khu 3, phuting Hang Ha, Tp. Ha Long, tinh Quang Ninh - Ch8 & hien tai: T6 4 khu 3, phatmg Hang Ha, Tp. Ha Long, tinh Quang Ninh 3. Con chua thanh nien (con de, con nuoi theo quy dinh caa phap luat) a) Con Ma nhat: - Ho vã ten: Nguyen Huy Tan - Ngay than nam sinh• 03/09/2004

HO Ichau thuerng tra: To 4 khu 3, phtremg H'ang Ha, Tp. Ha Long, tinh Quang Ninh Ch 8 a hien tai: TO 4 khu 3, phuang Hang Ha, Tp. Ha Long, tinh Quang Ninh

b) Con tha hai (tra len): (ke khai nen; con tha• nhcit)

- Ho vã ten: Nguyen Gia Bao - Ngay thang nam sinh: 03/010/2008 - HO khau thuOng tra: To 4 khu 3, phuang Hang Ha, Tp. Ha Long, tinh Quang Ninh - CM &hien tai: Ta 4 khu 3, phireing Hang Ha, Tp. Ha Long, tinh Quang Ninh

II. TH6NG TIN MO TA VE TAI SAN 1. Nha y, ding trinh xay dung: (Ngtrai ke khai 4r two UI ccic log! Milt, ding trinh xOy dvng khac do ban than, vo hoc chang, con eh= thanh nien s& halt hoc kr him mOt phan).

a) Nha - Nha thir 1: (Dia chi tai: TO 4 khu 3, phueing Hang Ha, Tp. Ha Long, tinh Quang Ninh ) + Loai nha: Bit thr Cap c6ng trinh: Cap II + Dien tich xay slung: 320 met vuong

Gia tri: 2 &mg ( nha va dat + Gila)/ chang nhan quyen ser hut: CB 839093 b) Citing trinh xay dung khac: - Cong trinh thir 2: (Dia chi tai: TO 57 khu 4, phuerng Bach Dang, Tp Ha Long, Tinh Quang Ninh) + Loal c6ng trinh: Nha er rieng lé Cap c6ng trinh: cap Iv + Dien tich xay dung: 120 met vuong.,Dien tich dat 241 met vuong

Gia tri: 500 trieu clang ( ca nha va dat Giay &lung nhan quyen so hat: CB 794686

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Ngtrtri nhain: Ngt.r61 ke khai:

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Quyen sir dung dat: (Ngtrai Ice khai ty• tn6 ta cac log! &it do ban than, vg• hoc chang. con chtra thanh nien c6 quydn sir dung tock b6 hoc mOt phan).

a) Dat g: - M61111 thir nhat: (Ghi theo tieng 16, khocinh, khuan vidn).

+ Dia chi: T6 61 khu 4, phuang Bach Dang, Tp Ha Long, Tinh Quang Ninh) + Dien tich: 30,62 met vuOng + GM tri: 500 trieu dong + GiAy chi:mg nhan quyen sir dung: BD 592215 - Manh thir 2:. + Dia chi: TO 4 khu 3, phugng Hang Ha, Tp Ha Long, Tinh Quang Ninh) + Dien tich: 151 met vuong + Gia tri: 2 tY. + Giay chimg nhan quyan sir dung: CB 839093 - Manh thir 3: + Dia chi: T6 57 khu 4, phugng Bach Dang, Tp Ha Long, Tinh Quang Ninh) + Dien deb: 241 met vuong + GM tri: 500 trieu + Gi'ay chirng nhan quyen sir dung: CB 794686

Tian (tin Viet Nam, ngoai te) gam tian mat,tin cho vay, tin gUi cac cá nhan, ft) chirc trong nugc, nuac ngoai tai Viet Nam ma tong gia tri quy d8i tir 50 trieu thing to' len. - 1,3 ty.

O to, mo to, xe gan may, xe may (may üi, may mac, the logi xe may Mac), tau thay, tau bay, thuyen va nIfirng dOng san kit ma Nha mot quan ly (theo quy dinh cUa phap luat phai clang ki sir dung \fa dirge cap giay dang ki) có tong gia tri moi loai tir 50 trieu (tong tit len. -0 to: 01 xe o t8 04 ch8 vios, gia tri 500 trieu d6rig. - Xe gan may: 02 xe gAn may, gia <50 trieu d6rig.

Kim loai quy, (Id quy, c6 phieu,,v6n gop vao cac ca se( kinh doanh, act:* giAy t6 c6 gia trj chuyen nhugng lchac c6 t6ng gia tri quy doi m6i loai tin 50 trieu dong tit len. - Khong c6.

Cac loai tai san lchac ma c6 gia tri quy deli men loai tir 50 trieu (long trer len (nhte cay canh, ba ban ghe, anh, do nij nghe va coy logi tai san khac). - Khong cg.

TM san, tai khoan a nu& ngoai g6m tat cã tai san quy dinh tin Khoan 1 den Khoan 6 noi tren nam ngoai lanh th6 Viet Nam. - Khong c6

Cac khoan ng g6m: Cac khoan phai tra, gia tri cac tai san quan ly hO, gift 110 co tang gia tri tin 50 trieu d6ng trey len - Khong cO.

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Ngurri nhan: Ngurni Re khai:

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9; Tiing thu nhap trong nam quy d8i thanh tien Viet Nam Om cac khoan Itratrg, phu cap, trg cap, thuerng, thu lao, cho, rang, bieu, thira ké, thu nhap htreing lgi tir the khoan dau tu, phat sinh, sang che, cac Ichoan thu nhap - Thu nhap cüa chong: Nguyen Huy Tien: 500 trieu clang/ nam. - Thu nhap cüa vg: Tran Thi Ngge Anh: 100 trieu (long/ nam. III. GIAI TRiNH Ski BIEN BONG COA TAI SAN, THU NHAP

Loni tai sin Tfing/giiim NO dung giai trinh nguon g8c tai sail, thu nhap tang them

Nha er, cling trinh xay chrng: (tang, giam ye so lugng, din tich, thay doi loai dat so vgi kY Ice khai trugc do):

Giant - Ban 1 manh dat va nit& tren dat tri gia. 1,2 tY:

+ Dia chi: To 61 khu 4, phugng Bach Dang, Tp Ha Long, Tinh Quang Ninh)

+ Dien tich: 35 met vu8ng , + Giay chirng nhan quyen su dung: BD 592216

Tien (tien Viet Nam, ngoai te) Om tien mat, tien cho vay, tien ggi ca nhan, to chgc trong nuoc, to chgc nude ngoai tai Viet Nam ma tong gia tri quy doi tir 50 trieu (tong tra len

Tang - CU cg 100 trieu dgng, - Tang them 1,2 ,tY(Ban

nha va dat); Tiet kiem tang 500 trieu thing( tir thu nhap 2 vg ch6ng).

- Tra ng 500 trieu Sing - C6n du: 1,3 ty.

4. Cac loai dOng san - 6 to

19ong thay doi

(Ngual ke khai tu xcic dinh cac log! red san tang, glean trong 1g) ke khal va giai trinh str tang, gicitn cita tai san thuac sá eat clia ban than, vv hoc chang, con chua thanh nien).

Ngay nh an ban ke khai titi san, thu hap Ngay thang k. namoMr

Ngirtri nifan ban ke khai (4, ghi ra hp ten, chat' ntichtit danh)

,Wiw p Traig

AP--- 1,6,75 71 024/13ni,

Ngay hoan thanh ban ke khai tai san, thu nhek NO.y thang a.. narn eitiF

Nguiri ke khai tai sin, thu nhlap (4, ghi rb- hp ten)

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Ngued than: Nguad ke khai:

Ghi chic Ngw&i nhOn ban ke khai, nguoi ke khai tai scin, thu nhap phial Id tren ding trang cita ban ke khai tai scin, thu nhap.

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Nguai nharc Ngirtri kö khai: