Mu s: 01/LPTB (Ban hnh km theo Thng t s 60/2007/TT-BTC ngy 14/6/2007 ca B Ti chnh)
T KHAI L PH TRC B NH, T
[01] Ngi np thu: ..................................................................................... [02] M s thu: ............................................................................................. [03] a ch: ................................................................................................... [04] Qun/huyn: ................... [05] Tnh/Thnh ph: ..................................... [06] in thoi: ..................... [06] Fax: .................. [08] Email: .................. C IM NH T: 1. t: 1.1 a ch tha t: 1.2. 1.3. 1.4. 1.5.
V tr (mt tin ng ph hay ng, hm):
Mc ch s dng t: Din tch (m2): Ngun gc nh t: (t c Nh nc giao, cho thu; t nhn chuyn nhng; nhn tha k, hoc nhn tng, cho): a) Tn t chc, c nhn chuyn giao QSD: a ch ngi giao QSD: b) Thi im lm giy t chuyn giao QSD ngy.......... thng....... nm............ 1.6. Gi tr t thc t chuyn giao (nu c): 2. Nh: 2.1. Cp nh: Loi nh: 2.2. Din tch nh (m2 sn xy dng): 2.3. Ngun gc nh: a) T xy dng: - Nm hon cng (hoc nm bt u s dng nh): b) Mua, tha k, cho, tng: - Thi im lm giy t chuyn giao nh ngy ............. thng ............ nm.............. 2.4. Gi tr nh (ng): 3. Tr gi tr nh, t thc t nhn chuyn nhng, nhn tha k, nhn tng cho (ng): 4. Ti sn thuc din khng phi np l ph trc b (l do): 5. Giy t c lin quan, gm: Ti cam oan s liu khai trn l ng v chu trch nhim trc php lut v s liu khai./ ..........................., ngy......... thng........... nm.......... NGI NP THU hoc I DIN HP PHP CA NGI NP THU K tn, ng du (ghi r h tn v chc v)