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  • CONSIUUL CONCURENTEI

    DECLARATIE DE AVERE

    pZ5~atiedp3~$;~~:'l-'rN[...:.' Data : : .

    ~~'i!ft?t::,~~/b;.:~.~~~:::.i~.l~~~~~:':.::~:::.;:NP:..~.avand fun~t;,lk r.aw.: U/~?"/. . . ,I~~:;~~~~~';ip~~~~derii:' ~~t:··29idi~ Cod~I··-penalprivind ~Isul /in'dedarati'i"'d'~~i~'; '1) I !

    proprie raspundere ca impreuna cu familia1ldetin urmato,arele: "')Prin familie se intelege sotulfsotia ~i copiii aflati in intretinerea acestora.

    I. Bunuri imobile 1. Terenuri NOTA: Se vor declara inclusiv cele aflate in alte tiki.

    __Adre~-;';~i~~~~-;-]~!i~~~~i~-,.. i

    I

    ..".,;"i:ftt~~~~1]~~f~~t~~Wl~-- ~:-tJ j ,

    I I' !·------------T---1·-- --'T-' --,--.------.--.----.- 1 =====---- I ! ! f----=.-~-==-~·'--+] -----.--------------r-.-----+-- -----+------+------------.------~ ·I ···.------··-------------·i---- +- ' +.- -....-..---------!----------------~ "'------:-~-~~~~~~t: (1) agricol; (2) forestieri (3) intravilan; (4; luciu de apa; ~5) alte categorii de te I'IJri extravilane, dad! se afla in circuitul civil. I l

    ')La "Titular" se mentioneaza, in cazul bunurilor proprii, numele proprietarului (titularul, sotul!sotia, copilul), la' Iin cazul bunurilor in coproprietate, cota-parte ~i numele coproprietarilor. I

    I I I 2. Cladiri I I I NOTA: I I Se vor declara inclusiv cele aflate in alte t~ki. I I

    ;-:---:'T

  • r

    I ~--~~ei,S:4mcirt· ;;~-,.:-.,;Y:- r :-~~:~~=-=~-=-=-~_--4c:~~----=l --~==:=~:H --------.----.-'"~'--. L ---..--- 1 .,

    III. Bunuri mobile, a ciiror valoare depa~e~te 3.000 de euro fiecare, ~i b ~I~ i imobile instrainate in ultimele 12 luni I i --

    --'{~ijrl~~l'iIt~~l!;Sr-'; -~a~oar ; C'] II' I ....1.;.~~~,.>;~~~~~,~~~.*;,..~~;~-.~....t" t. .' -.; -.. ', ;", ~ ! i~ 'II ! ----j 1

    ---r------------r-------- - 1- 1 I ' i 1-------------r-------------;------- - --l __.< 1 j 1

    -- ---~~~ Active financiare -1'--- 1. Conturi ~i depozite bancare, fonduri de investitii, forme echivalen

    economisire ~i investire, indusiv cardurile de credit, daca valoarea insumata a t t1t1r acestora depa~e~te 5.000 de euro

    NOTA: Se vor declara inclusiv cele aflate in banci sau institutii financiare din std3inatate. _ _._ I

    , __-_....._._.·-'_;~_~~~i_;_l_"::_,;~!_;L_;tQ_t:_:tt_;;~!~_~,ti.~~_;~_J..-_~·-.y_-·_- _ of,,; \-J~~~!~~~:~~iJl~.~~ela zi ;1' :!!ll I' - - - ----- -"-"-- - I I I ·=-'-'-l---'-'---~-c-'--'--c----c---.-- - --- "':1 ; 'I ~------------------------·------T- ---- I -------,------------------ - :1 --

    -__~_:~=~~~::===?[-/-~t==--L-J---=~=-~jji· ,--- Ii - - I i ---------- - --J " '- . I : _ i _' + ._

    • Categoriile indicate sunt: (1) cont curent sau echivalente (inclusill card); (2) depozit bancar sau echivale t!~f fonduri de investitii sau echivalente, inclusiv fonduri private de pensil sau alte sisteme cu acumulare (se vor decl roll aferente anului fiscal anterior). I

    2. Plasamente, investitii directe ~i imprumuturii acordate, dadi valoarea de insumata a tuturor acestora depa~e~te 5.000 de euro

    NOTA: Se vor declara inclusiv investitiile ~i participarile in strainatate.

    I

    12

    ·~---2~Bunu,Jubforma de ~2f!ioase, bijuterii,obiectede~r::~:d;~~~:c~Lj: de arta ~i numismatica, obiecte care fac parte din lilatrimoniul cultural national !;r universal, ~ caror valoare insumata depa~e$te 5.000 de euro 1

    NOTA: Se vor mentiona toate bunurile aflate in proprietate, indiferent daca ele se afla sau

    teritoriul Romaniei la momentul declararii.

    i I

    ----------_,,_. __ 0 ------ I .-------- --! ______~_-_~~~_-u -------- -------~---.-------------~ +=--=:~=---·-----t==_~:~~:_.~__~ _

    • categoriile indicate sunt: (1) hartii de valoare detinute (titluri de !itat, certificate, obligat;iuni); (2) act;iuni sua sociale in societati comerciale; (3) imprumuturi acordate in nume personal.

  • 3. Alte active producatoare de venituri netE!, care insumate depa~esc echivalentul a 5.000 de euro pe an:

    :..>::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~~::::::::::~:~:::::::::::::::::::::'::::'::.::.::.::...:.::.:.:...::::.:.::.:.::.:.....:.:--.[.. NOTA: - Se vor declara inclusiv cele aflate in strainatate. ', I V.Datorii Debite, ipoteci, garantii emise in beneficiul unui t,er1,bunuri achizitionate in si tl~

    leasing ~i alte asemenea bunuri, daca valoarea insumiClitaa tuturor acestora depa~ :p 5.000 de euro

    NOTA: Se vor declara inclusiv pasivele financiare acumulate in strainatate.

    ~__==-:=-~~~=-··~:·::i~;ctidii4r(:;;:~;~;;:;:E;~~{t;\!)1~~~~~,fihi~tJImi£'9~~[~~~~]~7m'sSB2T--v~';;a~e~.·i. t' l'i I, I . j I'I ,I I ---;------.-1-. ';I'

    .----.-.---- :---.--.----t T,--, ..-.~~-----t--·-..------..-1- +. ':I .. _ .... -•.....•.• ---.-----. .1......• ._. 1.__ . - .... --... --l ,.L:

    VI. Cadouri, servicii sau avantaje primite grcutuit sau subventionate fat- ~. valoarea de piata, din partea unor persoane, organizatii, societati comerciale, E ~i autonome, companii/societati nationale sau institutii publice romane~ti sau str illf' inclusiv burse, credite, garantii, decontari de cl1leltuieli, al,t,e..I.e. de.ca.t cele~i '. . angajatorului, a caror valoare individuala depa$e$te 50(JI de euro· :,

    ~Ctilr,:-:--:m:,.'··:O;T=-:-:-:::'--:::· ---- If! " Cine a rejl!i~a~"~~nlt,,Il. ...~i¥'i";-/::.-~.~:/{I_~\f.~"ltLiI;anLl2i1inc 5~~i ,;

    i.1.' Titular .J, :"'.'~"".'J.~"'.,~" 'J',.,~. '~_.:.2__ ._ -- r ~-==~~~~---.-_.-----------------..----- -l~==~~~==~=l-t:~::_~:.~=~y.:otie----.--.------r-----.---. I ---.------L-----------.-~--..!-i'

    I Iii ,:..... -. - - - - ..- .. - .. -- ..----------+- .. - - -... ---r---------·-------r-----------·+ ~.!, 1.3. Copii ! i I :._...:_:_.~...:~.~::=~_~~----.·..-···-·----..t-·---- .__ ~_~ ~~~~=~=·__-_-_-·--=-r- .=~=__~-:=__-~:-..~j

    • Se excepteaza de /a declarare cadourile ~i tratatiile uzua/e primite din partea rude/or de gradul I ~i al II-lea. , I VII. Venituri ale declarantului $i ale membrilor salide familie, realizate in ultim I a I

    fiscal incheiat (potrivit art. 41 din Legea nr. 571/2003 privind Codul fiscal, cu modific I ~i completarile ulterioare) I

    NOTA: I

    Se vo, decla,a Inclus;v venl'unle pcovenlte din s'''lln.,a:e ..,:.,,.;.,r"'- .,. _:". ~.:'; " . "'.;'.c- ..'~.;;.,t-::-=--~-=·-t.-Ie: ,,' J:~;!g~~:f~~t~~(~~lif~~Jy~IJ't~'..,~ua'_~ ~ ..i1

    1~t~Ef~~?~~~~~0~-==~·----r(J1;07HrkJt;.t ....~:~~~-. --- -- T--~_=_-T~l " f0'! f! (T-!L..~.':'.(!'!~?t. .. ~_Pay tV IU-8 ~ 9o.;t-~.--. ····l· '; I .1.._~=~.~=~~e______ I ---.-------"'--------- i- :1\ ! -1.3~;pii-.---- I . I .----- ... t- :11 : :1iJ 7#W~'!/!!f!'-1!!±~ ..l__u~_!;Jtc!.~....:..J~~ll!---~-~~--..--.----.-.=J'--.-Jd ?~~-. - .., JI '~illl 'I ~2.venit~r~.~~~:.~~~!~ati ~:!.~pe~de~~_ . ---- ....--------------- ..-------.-.f- ;J : I

    I ' ,

    I I : , ! I,

  • II I I ------ Ii::1 i ,------.---- - ~t:!I! i' I

    ·2:-i.--s~ti~~~~·_.. uu ---·- •• --·-·---r-;::-----·----T----::::) -------------\---.-----. .---1 ';1 I

    3_. -_~~_:-_;,_~~;;'=e=d~a-~~e-a-·--fO;~:~-t-e-i--b-;;;,U-,r-ilof----·---· i ---.-----------~~~------=j--~-.-----~~~~~Ji·· i.! 3.1. Titular -,,---------------------- ]L, ,.

    j~~--s~V;ot;~-:_==~i~=-------.~,---=:=--- - -T,:---~=--~---~~;,!, __________ . 1__ _ ~ .. ~

    4. Venituridin investitii T ' I'I I,4:i-:-m~iar ------! ---.--..-..-----.--.-·-,L.t'·f I, i'l! I • I :

    r------- i ---.--.----- -;1 I !

    .:~.:~=~:~_o~:=~_-.._-_.~==_-_-_~-__-_-__-_-...-__-_-_-_,-l-.. ------.--~---- l~------~.::---~;i' , 5. Venituri din pensii -----------......-'----- --------.---1,------.----.---- .-1-: : ; '5:l'-Tit~~----------------l--------'----=t===== I ------ it·:----..-------------·I-~~-~I--/--------·--t--..-·----------.i-; , ._

    S_._2__~_otJ_so~ie II I: ; -- ":1 I :_ _ I _.__ ._________ I 11 '_._.__.__.__~__. ._. ._.-=r__ --l-------·------· --Ji . I !, I ~~_ven!~~r~~~~_a_c_tivit~_t_i_a_g_rJ_·c_o_leT- =================~~ ~_-~-_~-__~~-_ -.1,': 'I ·6.1. Titular !I, ---0---------

    ! I I. --'--"'--t I ! I r'ii; I----------r-------------: I I ; ,! I , I

    "'"i.L. : I

    ±·:I:,.,.7.i~-nt~-i~~-------------------I'--- J ! -l"~::II I I 1'1_==~-·-·--------------I I --i------- ,--i-- I Ii 7.2_ So.'so.ie I ' --- --t

    Y > I I I : i .::~ i -----. ·-t i

    ____________________~I---------- .•.....--.-- I I ; 7.3. Copii I, ---~.----------.- .. ---- -f- 'I': '

    'I ..._-_~_..-~_=~_===-----..-------r -------',--------- -r I :;;~:::~~-·n-a-lt-e-s-u-rs--e------___"I I' --.===--------, -T--·-~~=-=-~-li'I

    I II '-' - -------'--- , I -,-------'-- -, ~-! ! I !--·------··--·------·-----"-~,I·- --r-----.----------.--j--.----.------ -_.

    8.2. SotJso~ie ! i _._._---,.__.--...._-..__._---------------.~--.----------r__---.------------!------.--------

    ! ! l-.- -----------------------------1- ----------------; ----.--------------r------------- ---_._- 8.3. Copii ; \ •__________ I . ------ I ,..~~=~===_~=~ ""T I -' T--==.~_== --i-::

    Prezenta declaratie constituie act public ~i raspund potrivit legii penale pe 1'T ':. inexactitatea sau caracterul incomplet al datelor men~iol'1ate. '1

    I I

    III I I

    Data completarii

    o.~:.P.~:_;1>.!~ .

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