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DECLARATlE DE A VERE

~"""""d pre"d,,;I, '" ;92d,~~~:i~,f~ztt;,;;';;;:;d~,;'; imprellna Cll familia ') detin unnatoarele :

I. Bunuri imobile I . Terenuri

NOTA: Se vor declara inclusiv cele aflate In alte ta ri .

---------------+----------+----------+---------+----------r---------+----Adresa sau zonaICategoria *, Anul ISuprafata tCota -parte Modu~ de t,

I Idobandlrll.l doband re + 7"7"~k2- - ~------+--~------+-t1~/J---+-~~--+----------+~-~~7~;+-- -------- • +~L~ -~~b_--+-~------+;J~~----+-~1g~--+----------+--~(~~--- -- -

:~=;~;~~;;;;~;~;;;;;;;~;~~~;;;~;~~;;~;;;;;;;;;;:~~=- --- -+----------- ----+----------+----------+---------+- - -------- t- ----- ---t­---------------+----------+----------+---------+----------+---------+

r--- --- - --------+--- -- -----+----------+---------+---------- +---------t-------­t---------------+-- --------+----------+-------- -+----------+---------+- -----.--~-------- -------+----------+-----------+---------+---- -- ---- +-_._------+-----­

- ------------~---------- + ----------+---------~--------- - +---------+--

---------------+----------~-------- - -+---------+--- -------+--- -----~

+---------------+- - --------+----------+---------+---------- .- ---- ---+------------ --- + ----------+----------+---------+---------- ~-------- .-+---------------+----------+----------+---------+----------+-------- ~- - - -

- --- -----------+- ---------+------ -- --+---------+---- ------+- ---- ----+----• Catcgoriile il1dic"~e sun!: (I) agricol ; (2) forestier; (3) imravilan; (4) luciu de apa: (5) aile catcgorii de

It..:rcnuri cxt ravilane, daca se afla in circuitul civil

2. Cladiri OTA:

Se vor declara inc lusiv cele anate 111 alte tari.

~- ------ - --.- ----+----------+----------+---------+---- ------ +---------+-----

Adres'3 f'"l<j zona!Categoria*1 Anul ISuprafatalCoLa-parte Modul je T -ll'ar

.~~---~-----~-.~-------~~;~~:~~!--~~--~ - ---------+~~~;~~~ -_ _ _~ __ +_~------.;f...j.J-'7- ---+---------' ---_______ JAjJJI~ _ 'I

~ __ ~~:7~==:=~======:J{~~~===:==Z~~===:==========~~~='~---_ ~~~~~~====:==~======:=~=~==:==~~===:==========:~~~--+--- ------------+-----------+----------+---------+----------+----- ---~-----

--- -t

--- +

--- +

+---- ----------- ~ ----------+----------~---------+----- ----- + ------- --+-------­

+------- - --- ----+_._ --------+----------+---------+----------+---------+­~------------ --- + ---------- +----------+---------+----------~---- ----+ -------------- ---+----------+------- ---+---------+-- --------+- -------- ---- -~-- --------------+---------- + ------ - - -- +--------- +---- ------+---------+-------- -• Categorii le indicate sunt: (I) apartament; (2) casa de locuit; (3) casa de vacanta: (4) spatii

col11crciale/de productie. ') Prin fam ilie se Illtelege sotul /sotia si copiii aflati 111 intretinerea accstora.

2) La "Titular" se mcntioneaza, In cazul bunurilor proprii, numele proprietarului (titularu!. sotul /sol ia, ~opi lul), iar In cazul bunurilor In coproprietate, cota-parte si numele coproprietari lor.

II, BUlluri mobile I. Autovehicu le/autoturisme, tractoare, masini agricole, salupe, iahturi si alte mijloace de

transport ca re sun t supuse Inmatricularii , potrivit legii

T------------+ -------------+-------------+------------ ------+------------------~

Natura I Marca INr . de bucatilAnul de fabricatie lModu' de doband_ r

~;i~~~~~~~--~~~~;;~~~:::~~~~~~;:;~~~~----j::~~~::: +------------+------------ -+-------------+------------- -----+-----------------­+------------+-------------+--------- ---- +------------------+------------------; +- -----------+----- --------+-------------+------------------+-------------- ----t +----- -------+-------------+-- -----------+------------------+--- -,------------~

+--------- ---+- - --- --------+-------------+------------------+---------------- -­~------ ------+------------ - +- ------------ +------------ ------+--------- --------­

~---- --------+-------------+------------- +----- -------------+---- ---------~----,

2. Bunuri sub forma de metale pretioase, bijuterii, obiecte de arta s i de cult, co lectii de arta si nu mismatica, obiecte care fac parte din patrimoniul cultural national sau universal, a caror valoare Insumata depaseste 5.000 de euro

OT": Sc vor mentiona toate bunurile aflate In proprietate, indiferent daca e le se afla sau nu pc teritoriul Romaniei la momentul decla rarii .

~--- ------------- ----------+------------ -----------+-- -----------------------I Descriere sumara I Anul dobandirii I Valoarea est.imata I +--/~~- ~~"---:f=~----~--+--------------------- --+------------ --- --------- -. !'~~jilR-~~~1"-~---+------------ -----------+-------------- - __ ____ _____ +

+=== __ =?J===ZC.W?K?========:===J1'lE:=~lZ======:====imp~JL~== ======_=_=: +--------------------------+-------- ---------------+-------- -----------------­+--------------------------+--------- - -------------+-------------------------- + --------------------------+-----------------------+----- --------- --------- +

+--------------------------+- ---------------- ------+- ------------------------ + +-- --- - --------------------+-----------------------+-- - --------- ---------------~

III. Bunuri mobile, a caror valoare depaseste 3.000 de euro fiecare, si bUlluri imobilc instrai ll atc III ultimele 12 luni

+------------------+-----------------+-------------------+------- -----.------- ~

Natura bunului IData instrainariilPersoana catre carel For~a Va~oared

instrainat I I s-a instrainat linstrainarii +----- ------~ --+ -------- ---------+- -- ----------------+--- - -- ------+--------+ +------------------+ -----------------+- ------- -----------+------ ------~-------­

~----- ------------ - + -----------------+------------------ -+------------~------­+--- ---------------+-----------------+- -------- ----------+------------+--------+ +--- ---------------+-----------------+-------------------+- -----------+----­+--- ---------------+-----------------+-------------------+------------+------_. + +------------------+-----------------+---------------- --- +------------~-------­

+------ ------------+-----------------+------------ -------+-------- ----+------­+----- ----------- - - + --------- --------+ ---------------- ---+--------- ---.--------~

rv. Active financiare I. Conturi si depozite bancare, fonduri de in vestiti i, forme ec hival ente de economis ire s i

inveSlire. inc lus iv cardurile de credit, daca valoa rea insumata a tuturor acestora depasesle 5.000 de ellm NOTA: Se vor dec lara inclusiv cele aflate in banc i sall inst itutii finan ciare din stra inatate .

+--------------------- - -------+ ------ +------+ ------ -- ---- ---+------------------+

1 Institutia care administreazalTipul*IValutalDeschis in anullSold/valoare ~a z. I si adresa acesteia I J I I +------- - ---- - - -- - - - - ---- -----+ ------ +------+ ---------------+ - - - ---------------+

~---- - - -- --- ----------------- -+- - ----+ ------ + - - ---------- - - - + --- - --- - - ---------~ +--- -------- - ----- ------------+------+-- ----+------ ---- - - - - -+ --- ---- - --------- ~

+------------- ----------------+------+---- --+ - ------ ------- -+----------------­+------ ------- - -- - -------- --- - + - -- -- - + --- ---+ --------- ---- - - +------------------~

+-------- ----- --- -------------+------+ ------+ ------ - -- - --- -- + ------ -- - - - - -----~~ +- _________ __ __ __ ____ _________ + ______ + ______ + ______ __ _ ------+-- - - - -------------r

• Categori ile indicate sunt: (I ) cont curent sau echival ente (inciusiv card) ; (2) de poz it ba ncar sall echiva lente; (3) fondllri de investitii sau echivalente, inci us iv fond uri private de pens ii sall alte sistem e e ll aClIm lil are (se vor deciara ce le aferente anului fi scal anterior).

2. Plasamente, investitii directe s i imprumuturi acordate, daca valoarea de piata insllmala a tlilu ror aceSlOra depaseste 5.000 de euro

NOTA: Se vor dec lara inc lus iv investitiile s i partic iparile in stra inatate.

t- ------------------- -------------------- ------ - ---- +--- ------+-------------------+--------------- --+

Enit.ent titlu/societatea in care persoana I Tipul * Nr. de titluril IValoarea tetala -->-d Z I p.ste act~onar sau asoc i at/be neficia r de imprumut I ICo t a de participare

;l-tlln,~==~=1fjji=(if1t=~~~=ii=:==~====:====ili~=======:==~f:tffff~-; ------,---- -------------------------------------- +---------+----------------_.-.-----

----- ---------- --------- ----------- - ----------- +---------+-------------------+----- ---+ -------- ---~---------- --------------------- -- -----+----~----+- ------------ - -----+ .. _---_ .. -

-------- ------------ - - ---------------- --- - ------- +- --- - - -- - +-- - ---- -- - ---------+----------

• Categoriil e indi cate sun!: (I) hartii de valoarc detinute (titluri de stat, certifi cate, ob li gatiuni); (2) aClili ni sa u parti soc ia le in societati comerciale ; (3) imprumuturi acordate in nume persona l.

3. Alte active producatoare de venituri nete, care insum ate depasesc echiva lenl ul a 5.000 de euro pe an:

NOTA: Se VO l' dec lara inc lus iv cele aflate in strainatate .

V. Datorii Debi lc, ipotec i, ga rantii emise in beneficiul unui tert , bunuri achiz itionate in sistem leas ing si aile

ascmenea bunuri, daca va loarea insum ata a tuturor acestora depaseste 5.000 de e uro NOTA : Se vor dec lara in c lus iv pasivele financ iare acumulate in strainatate .

~------ ----------------+----------------------+----------------+---------- -----Creditor Contractat in anul Scadent la Vdl ar~

~------ ----------------+----------------------+----------------+------ ---------+ ~--------- -------------+----------------------+----------------+------,-----­

+----------------------+----------------------+----------------+--------------­~----------------------+-------- --------------+----------------+---------------t

+----------------------+----------------------+----------------+---------------t ~----------------- -----+-- ------- -------------+---------------- +----------- --­+----------------------+----------------------+----------------+--------------

VI. Cadouri , servicii sau avantaje primite gratuit sau subventionate fata de valoarea de piata din partea unor persoane, organizatii, societati comerciale, regii autonome, companii/societati nationale sau institutii publice romanesti sau straine, inclusiv burse, credite, garantii , dccontari de che ltuicli , altcle dedit cele ale angajatorului, a caror valoare individuala depascstc 500 de curo·

+--------------------+----------------+--------------------------+-------------Cine a realizat ISursa venitului : IServiciul prestat/ObiectullVenitul a:1I~"'l.

venitul I numele, adresa I generator de venit I incasdL +--------------------+----------------+--------------------------+------------

1.1. Titular +--------------------+----------------+--------------------------+-------------+ +--------------------+----------------+--------------------------+-------------+

1.2. . Sot/sotie +--------------------+----------------+--------------------------+-------------t +--------------------+----------------+--------------------------+------------ ~

1 . 3 . Cop!! +------------- -------+----------------+----------------------- ---+-------------~

+--------------------+----------------+--------------------------+-------------+

• Se excepteaza de la declarare cadourile si tratatiile uzu'l le primite din parlea rudelor de gradul lsi " I II-lea.

VII. Venituri ale declarantului si ale membrilor sai de familie, realizate ill ultimul an fiscal illcheiat (potriv it art. 41 din Legea Ilr. 571 /2003 privind Codul fi sca l, cu modificarilc si complctarile uitcrioare)

NOTA: Se vor dec lara inc lusiv veniturile provenite din slra inalate.

+-----------------------+----------------+--------------------------+------------IC_ne a realizat venitull Sursa venitului : I Serviciul prestat/Obiectu-,- Ven ... tu-,- ant.:al I I numele, adresa I generator de venit ~n~dsa~

----- ------------+----------------+--------------------------+---II. . Ven~turi din salarii + - -- - - -- - - - - ---- --- - - - - -+ ~ ------ -- - - --- + - - - --- --- - --.- ---- - - -- - -- - -+ - - - - - - -- - - - - - - - ~

; ~~=~ - ~-=~=:~----------+-l.J.r,-~[@A'~----AjJl!-..ft-r~~--~---.r:q~9:'?. ____ •

t ---------------- ------+--------------- -+--------------------------+- --------------~

11.2. Sot Isotie I -« -.- I <-- 1..- I ~Cl:lO +-----------------------+----------------+--------------------------+----------- --+ I I I +-----------------------+----------------+--------------------------+---------------+ 11. 3. CopE +-----------------------+----------------+--------------------------+----- --- -- -+ ----------------------+----------------+--------------------------+--------- -

2 . Venituri din activitati independente ~-----------------------+----------------+--------------------------+------------

+~~_~_::::~~:~ ___________ !--~-~ !vf.tJ.---- -!--!fjI}Et-IJE'L-~1f!~\.--------= --+

.- - t

1

::~: ~-;c~~::~::---------~-~t4'~~-~1~-;l:--~-------------------------- + ---------------+

+---- -- -----------------+----------------+------~-------------~ -+------------! ___________________ ~~~~IC.~!~!~4-~~~~-!-----~---~~--~g~-- _~+-------~ I~. Venltur~ d~n cedarea folos1nte1 bunur1lor

-+

~-------------- ---------+----------------+-------------------------- +---------------+ 13.1. Titular ~-----------------------+----------------+------------------------ --+--- _. ------ --+

+-----------------------+----------------+--------------------------+-------------- + 13.2 . Sot/sotie +-----------------------+----------------+--------------------------+---------------+-----------------------+----------------+--------------------------+---------------+ 14. Ven~turi din investitii ~----------- ------------+----------------+------------------------- -+---------------11.1. ritular +-----------------------+----------------+--------------------------+------------~ -----------------------+----------------+------------------------- -+------------4.2 . Sot/sotie

+-----------------------+----------------+--------------------------+-----------_. --+

~-----------------------+----------------+------------------------- -+---------------t 5. Ven1turi din pensii

~----------- ------------+ ----------------+------------------------ --~---------- -+ :'.1. Titular

r- ----------------------+----------------+--------------------------t------ • -----------------------+----------------+--------------------------+----_._-- +

5 . 2. Sot/sotie .-------- --------------+----------------+--------------------------+-----------+--- -- -- ----------------+----------------+--------------------------+---------------~ 16. Venituri din activitati agricole +-----------------------+----------------+--------------------------+-- -- ---16.~.Tltular

t-----------------------+--------··----- -+--------------------------+--------------+-----------------------+----------------+--------------------------+---------------+ 16 . 2 . Sot/sotie ~----------- ------------+----------------+------------------------ --+---------- --_.+

~--. --------------------+----------------+--------------------------+-----_. +

I ,. Ven~turi din premii si din joeuri de noroe f----- ------------------+----------------+--------------------------+---------- - .--~ 17.1. Titular +-----------------------+----------------+--------------------------+-----------t-----------------------+----------------+--------------------------+---------------+

7.2 . Sot/sotie +-----------------------+----------------+--------------------------+------------t-----------------------+----------------+--------------------------+--------17 . 3 . Copii +-----------------------+----------------+--------------------------+--------i-----------------------+----------------+--------------------------+------------ --t

8 . Venituri din alte surse

+;~~~-;:~:~~~ --- -- ------ ~ -~------·-;;t,---~;-0:~---&~i£l2;;;-ct;+---------ii --+

~-----------------------~j~-~~---G'~~~~-------- ______________ ~-----~-- ___ _

+----------- ------------+------ ----------+--------------------------+---------------+ 8 . 2. Sot/sotie

.--- -------------------+----------------+--------------------------+------ ---

t----------- ------------+----------------+--------------------------+------------ --+

8.3. COPl1 +-----------------------+----------------+--------------------------i---------------

+-----------------------+- ---- -------- --- + --- - -------- ----- ---- -----+---------------~

Prczenta declaratie constituie act public si raspund potrivit legii penale pentru inexactitaLea sau caracterul incomplet al datelor mentionate.

L r mpletarii

. og .of: .. ~.I!. ........ . .

· '/EHt9w 1'1 DFCLARl'll!I:Dl 1\llLRl:SE ~ • vdU ~Jf~ Jrltr!.

~uQ6e'11n§tul/t>Ubscm alH' .... G1i'................ ... ..... runCl," de ·~r·· · · .. i; .......................................... ( ... j~ ... ....... ........ . la .. ..... lk1f~ .. v..~.CI.. ~f.. ...... CtiM<.:l ...... . , CM domicil ial in .. . .... .... .. .. 1 ..... .. .. 1.: .. ................................ .. / ..... · ........... ..... . cunos and prevederi le art. 2 2 din Codlil '£nal privind ral sul in declaralii , dec lar pc propria raspundcr : d

+---------------------------------------------------------------------------------------------------------------------------+ 11 . Asocjat sau actionar 1a societati comerciale , companii/societati natlonale , institutii de credit , grupuri de interes !economic , precum si membru in asociatii , fuodatii sau alte organizati~ neguvernamentale : +--------------------------------------------------+-------------------------+---------------------+------------------------+

Unitatea Nr . de parti Va loa rea totala a - denumirea si adresa - Calitatea detinuta sociale sau partilor sociale

de actiuni si/sau a actiunilor +--------------------------------------------------+-------------------------+---------------------+------------------------+ 11.1. . . .. I I I I

l~~~~~~~~~~~~~~~~~~~~~~:2~~~~~~ ~~~ ~ ~~~1'-~~~~~~~~~~~~~~~ l~~~~~~~~~~~~~ ~ ~ ~~I~~~~~~~~~~~~~~~~~~~~ l I

+--------------------------------------------------+-------------------------+---------------------f------------------------+ 12 . Calitatea de membru in organele de conducere , administrare si control ale societatilor cornerciale , ale regiilor lautonorne , ale cornpaniilor/societatilor nationale , ale institutiilor de credit , ale grupurilor de interes economic , ale jasociatiilor sau fundatiilor ori ale altor organizatii neguvernamentale : t------------------------------------------------------------+--------------------------------- t----------------------------t

Uni atea Cali tatea detinuta Valoarea - denumirea si adresa - beneficiilor

+------------------------------------------------------------t---------------------------------t----------------------------+ 12 . 1. .. . t-------- ----------------------------------------------------t---------------------------------+----------------------------+ +------------------------------------------------------------+---------------------------------+----------------------------+ i-------------- - ------ - ------------------------------------- - ~- - -------------------------------+------------ -- --------------+ .3 . Cali atea ~e ~embru .n cadrul asociatiilQr pr :es~o~a 2 si/sau S101 cale:

------------+ 13.1 . . . . .

._-- --- +

+------------------------------------------------- ----------------------------------------------------------------------- -+

':I.... f cl jc; nut "0 r ~ le 0> , t .. ,tld)t .::I r ~ 1 u ..... t.

4.1. ....

f------------ .~-----~!-~---------- -~-~-- ------ ---~-~--- -------- ----- -------- ---------------___ +

:~~~~~~~~~~~~-~~~~~~~~~-~~~~~~~~~~~~~~~~~~~~-~~:::~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~-~~~~~~~~~~~~~~~~~~: 15 . Contracte, inclusiv cele de asistenta juridica, consultanta si civile , obtinu e sau ailate in derulare in timpul lexercitarii functiilor, mandatelor sau demnitatilor pub11ce f10antate de 1a bugetul de stat, local si din fonduri externe lori incheiate eu sacie ati comerciale eu capital de sta~ sau unde statuI este aetionar ma]oritar/minoritar: t- -----------------------------------------+---------- ---+--------------+---- -------- t------------t------------+------------+

I Institutia IProcedura prinl Data Valoarea 5 . 1 Beneficiarul de contract: J contractanta: I care a fast I Tipul I incheierii I Durata to ala a

nurnele , prenumele/denumirea si adresa I denumirea I incredintat lcontractuluilcontractuluilcontractuluilcontractuluil I si adres. I contractul I I I I I

f---- --------------------------------------f----------------------------+------------+------------+------------+------------f I Titular .. ..... . .•.... f-------- --- ------------------ -------------f-------------f--------------f------------f------------f------------f------------f I Sot! sotie ....... . .... . +------------------------------------------f-------------+--------------+------------+------------f------------f------------f IRude de gradul II) ale Ititularului ........ . +----------------------·------- ----- -------f-------------+--------------f------------f------------f------------f------------f ISocietati comerciale/Persoana fizica lautorizatal Asociatii familiale/Cabinete lindividuale , cabinete asociate , societati Icivile profesionale sau societati civile Iprofesionale cu raspundere limitata care Idesfasoara profesia de avocat/Organizatii Ineguvernamentale/Fundatii/Asociatii 2 )

+------------------------------------------f-------------+--------------+------------f------------+------------f------------+

I) Prin rude de gradull se lntelege parinti pc linie ascendenta si copii pe linie descendcnta. 2) Se vor declara mnncle, dCl1umirea si adresa beneficiarului de contract unde, prin calitatea detinuta, titularul , sotul/sotia si rudelc de gradull obti n

contracte, asa cum su nt definite la pct. 5.

Pre/cnta declaratic constituie act public si raspund potrivit legii penaic pentru inexactitatea sau caractcrul incomplet al date lor mentionate.

Qata comp 1 etarli

.. 0-'1 o.~~. ~ II . .. ..... .. .. .. .