Oświadczenie członka rodziny o dochodach osiągniętych w roku

Transkrypt

Oświadczenie członka rodziny o dochodach osiągniętych w roku
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
"#$#% # &'()#*+, -(.,&+' /,0(#&12
)
,-./012 34/3)2 5,460)7,1 /48),)1,29,1029),:/;<4/=>829).)7,6?
60@34107 ,.8A)B,B7 31 0C;28A),673:D)40)6>E78)?:>0@043)C3:>)
B70.,)1,)-./012 34/0).829,.0.2 3<,D /44829)4/F)1,29,18)
B,1@3<0C;23),B,10>6,.04/? B,10>6/3A)1,29,1,.8A),1),:EG)
H/ 82 4829)40) 0:01029),673-@,4829 .)07>I)+JD)07>I)KLGD))07>I)KL2D)07>I)
KL3)/)07>I)KLH)?:>0.8) )14/0)+M)@/B20)NOON)7I),)B,10>6?)1,29,1,.8A),1
,:EG)H/ 82 4829)P1 I)?I) )+LN+)7I)B, I)KMND) )BEQ4I) AIR3
45)#'0-('$6 78 ) /,+9 +':8&0'/(,)1$33 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 9(1*+'.'$;9(1*+'.8$ 0,-<=0 )
)1*,+,5-# !!!!!!!!!!!!!!!!!!!! (. !!!!!!!!!!!!!!!!!!! >/ ( ?1?9.9@
A2 >,*B,0'/*?)' /,:&8>,3332
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! (. "B,)#8/(-<&#' >,*B,0'/*?)' ) <'
B/(8:#-(8&#,)1-< !!!!!!!!!!!!!!!!!!!!!!2
C2 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
D2 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
E2 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
32 45)#'0-(8&#8 )1B8.&#' # B,0B#*9F8 +'701 -(.,&8+ /,0(#&16 +?=/1 ,*#G>&G. ))! 0,-<=0!
332 HB#*'I /,+ +':8&0'/(,)16 ( +?=/8>, 0,-<=0 *?'&,)# B,0*?')% 9*?':8&#' 0,-<,09 /,0(#&1 ) B/(1B'0+9 9J#8>'&#' *#%
, 5)#'0-(8&#8 )1-<,)')-(8 ") B/(1B'0+9 9J#8>'&#' *#% , 5)#'0-(8&#8 )1-<,)')-(8 &' ,+/8* ?/)'FG-1 ,0
A +)#8?&#' CKAL /! 0, DK )/(85&#' CKAM /!6 &':871 )B#*'I /,+ CKAE2!
3332 AC N B/(8-#%?&' :#-(J' <' B/(8:#-(8&#,)1-< ) /,+9 +':8&0'/(,)1$ B,B/(80('FG-1$ ,+/8*6 &' +?=/1 9*?':'&8 F8*?
B/'), 0, 5)#'0-(8&#' )1-<,)')-(8>, N +),?' $#8*#%-(&8>, 0,-<,09 ( A <' B/(8:#-(8&#,)8>, ,>.'*('&' ) 0/,0(8
,J)#8*(-(8&#' B/(8( O/8(8*' P.=)&8>, Q/(%09 R?'?1*?1-(&8>,!
$
$
BST$%U&'U
45)#'0-(8&#8 ,J8F$9F8 &'*?%B9FG-8 0,-<,01 &#8B,0:8>'FG-8 ,B,0'?+,)'&#9 &' B,0*?')#8 B/(8B#*=) , B,0'?+9
0,-<,0,)1$ ,0 ,*=J S#(1-(&1-< "'/?! D B+? A :#?! - 9*?')1 ( 0&#' CT :#*?,B'0' CKKD /! , 5)#'0-(8&#'-< /,0(#&&1-< "U(! Q!
( CKAV /! B,(! AAE6 ( B=W&! ($!22 @
/8&?1 ,+/85:,&8 ) B/(8B#*'-< , (',B'?/(8&#9 #&)':#0=) ),F8&&1-< # ),F*+,)1-< ,/'( #-< /,0(#&6
/8&?1 )1B.'-,&8 ,*,J,$ /8B/8*F,&,)'&1$ # -(.,&+,$ #-< /,0(#& B/(1(&'&8 &' ('*'0'-< ,+/85:,&1-< ) B/(8B#*'-< ,
(',B'?/(8&#9 #&)':#0=) ),F8&&1-< # ),F*+,)1-< ,/'( #-< /,0(#&6
5)#'0-(8&#' B#8&#%7&8 ,/'( /1-('.? 8&8/>8?1-(&1 ,+/85:,&8 ) B/(8B#*'-< , 5)#'0-(8&#9 B#8&#%7&1$ # 9B/')&#8&#'-<
B/(1*.9>9FG-1-< 7,.&#8/(,$ ('*?%B-(8F *.97J1 ),F*+,)8F B/(1$9*,), ('?/90&#'&1$ ) +,B':&#'-< )%>:'6
+'$#8&#,.,$'-<6 ('+.'0'-< /90 9/'&9 # J'?':#,&'-< J90,):'&1-<6
0,0'?8+ +,$J'?'&-+#6 /1-('.? 8&8/>8?1-(&1 # 0,0'?8+ +,$B8&*'-1F&1 ,+/85:,&8 ) B/(8B#*'-< , +,$J'?'&?'-< ,/'(
&#8+?=/1-< ,*,J'-< J%0G-1-< ,S#'/'$# /8B/8*F# ),F8&&1-< # ,+/8*9 B,),F8&&8>,6
5)#'0-(8&#8 B#8&#%7&8 ,+/85:,&8 ) B/(8B#*'-< , 5)#'0-(8&#9 B#8&#%7&1$ B/(1*.9>9FG-1$ ,*,J,$ 08B,/?,)'&1$ 0,
B/'-1 B/(1$9*,)8F ,/'( ,*'0(,&1$ ) ,J,('-< B/'-1 B/(8( XXX Y(8*(% Z#8$#8-+G :9J [)#G(8+ R,-F':#*?1-(&1-<
Y8B9J:#+ Y'0(#8-+#-<6
8$8/1?9/1 # /8&?1 ,?/(1$1)'&8 B/(8( ,*,J16 +?=/8 9?/'-#.1 )(/,+ ) )1&#+9 0(#'.'\ ) :'?'-< A]D] A]EV :9J 8+*B:,(F#
B,(,*?'.1-< B, ?8F ),F&#8 &#8)1B'.=) # &#8)1J9-<=)6
/8&?1 #&)':#0(+#8 ( ?1?9.9 #&)':#0(?)' ),F8&&8>,6 +),?1 (',B'?/(8&#' ,?/(1$1)'&8 B/(8( ,S#'/1 ),F&1 ,/'( -(.,&+=)
#-< /,0(#&6 /8&?1 )1B'0+,)8 ,*=J6 +?=/1-< #&)':#0(?), B,)*?'., ) ()#G(+9 ( B/(1$9*,)1$ B,J1?8$ &' /,J,?'-< )
XXX Y(8*(1 Z#8$#8-+#8F ) :'?'-< A]D] A]EV6 ,?/(1$1)'&8 ( ('>/'&#-16
!"
!"#$%&$ '()*)+),- )&*-./)0- , 1*!-1$#"'( ) 2+-!1$-'!-0$2 #1)%-'!034 *)/0$&5, )*"! , 1*!-1$#"'( ) #3#6-4$2+-!1$-'!-7 #1)%-'!03'(8
.*)9&$ +-!!,*)60-: 1)4)'3 !";*"0$'!0-: )6*!343,"0- )9 *!<95, 1"7#6, )+'3'(8 )*;"0$!"':$ 4$=9!30"*)9),3'( /2+
4$=9!30"*)9),3'( $0#6362':$ >$0"0#),3'( 1)'()9!<'- !- .*)9&5, +-!!,*)60-: 1)4)'3 1*!3!0"03'( 0" 1)9#6",$:-90)#6*)00-: 9-&/"*"':$ /2+ 245, !","*63'( ! 634$ 1"7#6,"4$8 )*;"0$!"':"4$ /2+ $0#6362':"4$ 1*!-! ?"9= @$0$#6*5,8
,%".'$,-;) 4$0$#6*" /2+ ";-0':- *!<9),-8 , 634 *5,0$-A , 1*!31"9&"'(8 ;93 1*!-&"!"0$- 63'( .*)9&5, :-#6
9)&)03,"0- !" 1).*-90$'6,-4 1)94$)62 21),"A0$)0-;) 9) *)!9!$-/"0$" .*)9&5, +-!!,*)60-: 1)4)'3 !";*"0$'!0-:
0" *!-'! 1)94$)65,8 &65*34 4" #%2A3B 6" 1)4)'8
0"/-A0).'$ !- #6)#20&2 1*"'3 /2+ ! 6362%2 #631-09$24 )#5+ >$!3'!03'( 4":<'3'( 4$-:#'- !"4$-#!&"0$" 0" 6-*36)*$24
?!-'!31)#1)/$6-: C)/#&$-:8 1*!-+3,":<'3'( '!"#),) !" ;*"0$'< , ,3#)&).'$ )91),$"9":<'-: *5,0),"*6).'$ 9$-6 !
6362%2 1)9*5A3 #%2A+),-: 1)!" ;*"0$'"4$ &*":2 2#6"/)03'( 9/" 1*"'),0$&5, !"6*290$)03'( , 1"7#6,),3'( /2+
#"4)*!<9),3'( :-90)#6&"'( #>-*3 +29A-6),-: 0" 1)9#6",$- 2#6",3 ! 90$" DE '!-*,'" FGHI *J K L)9-&# 1*"'3 MN!J OJ !
DPFI *J 1)!J FQPD8 ! 15R0J !4JS8
0"/-A0).'$ 1$-0$=A0- ,31%"')0- 1)/$':"06)48 A)%0$-*!)48 '-/0$&)4 $ 1*"'),0$&)4 :-90)#6-& ,):#&),3'( $ :-90)#6-&
1)/$'3:03'( 2A363'( 1)!" ;*"0$'"4$ 1"7#6," , '-/2 29!$"%2 , &)0>/$&'$- !+*):034 /2+ ,!4)'0$-0$" #$% 1"7#6," "/+)
1"7#6, #):2#!0$'!3'(8 4$#:$ 1)&):),-:8 "&':$ !"1)+$-A-0$" "&6)4 6-**)*3!42 /2+ $'( #&26&)48 " 6"&A- 0"/-A0).'$
1$-0$=A0- ,31%"')0- A)%0$-*!)48 1)/$':"06)48 '-/0$&)4 $ 1*"'),0$&)4 1-%0$<'34 >20&':- )+#-*,"6)*5, , 4$#:"'(
1)&):),3'( )*;"0$!"':$ 4$=9!30"*)9),3'( $ #$% ,$-/)0"*)9),3'(8
0"/-A0).'$ 1$-0$=A0- !- #6)#20&2 #%2A+),-;) )6*!343,"0- , '!"#$- #%2A+3 &"0939"'&$-: 1*!-! >20&':)0"*$2#!3
C)/$':$8 C"7#6,),-: T6*"A3 C)A"*0-:8 T6*"A3 U*"0$'!0-:8 V$2*" W'(*)03 ?!<928 )+/$'!)0- !" )&*-#8 , &65*34 )#)+3 62!3#&"%3 9)'(598
9)'()93 '!%)0&5, *)/0$'!3'( #15%9!$-/0$ 1*)92&'3:03'( ! 6362%2 '!%)0&)#6," , *)/0$'!-: #15%9!$-/0$ 1*)92&'3:0-:8
1)40$-:#!)0- ) #&%"9&$ 0" 2+-!1$-'!-0$" #1)%-'!0-8
"/$4-063 0" *!-'! 9!$-'$8
#631-09$" 9)&6)*"0'&$- $ ("+$/$6"'3:0- 1*!3!0"0- 0" 1)9#6",$- 2#6",3 ! 90$" FI 4"*'" DPPX *J ) #6)10$"'( 0"2&),3'( $
6362/0"2&),34
)*"!
)
#6)10$"'(
$
6362/,
!"&*-#$#!62&$
MN!J OJ ! DPFI *J 1)!J FYQD8 ! 15R0J !4JS8 #631-09$" 9)&6)*"0'&$- )&*-./)0- , "*6J DPP 2#6J F 2#6",3 ! 90$" DH /$1'"
DPPQ *J K C*",) ) #!&)/0$'6,$- ,3A#!34 MN!J OJ ! DPFD *J 1)!J QHD8 ! 15R0J !4JS8 #631-09$" #1)*6),- 1*!3!0"0- 0"
1)9#6",$- 2#6",3 ! 90$" DQ '!-*,'" DPFP *J ) #1)*'$- MN!J OJ ! DPFE *J 1)!J FHES )*"! $00- #631-09$" ) '("*"&6-*!#)':"/034 1*!3!0"0- 2'!0$)4 /2+ #629-06)48
&,)63 9$-6 0$-)1)9"6&),"0- 1)9"6&$-4 9)'()9),34 )9 )#5+ >$!3'!03'(8 )6*!343,"0- 1*!-! )#)+3 ,3&)02:<''!300).'$ !,$<!"0- ! 1-%0$-0$-4 )+),$<!&5, #1)%-'!03'( $ )+3,"6-/#&$'(8
0"/-A0).'$ 1$-0$=A0- )6*!343,"0- ! 6362%2 ,30":42 1)&)$ ;).'$003'( , +2930&"'( 4$-#!&"/03'( 1)%)A)03'( 0"
6-*-0"'( ,$-:#&$'( , ;)#1)9"*#6,$- *)/034 )#)+)4 1*!-+3,":<'34 0" ,31)'!30&2 )*"! 2!3#&"0- ! 6362%2
,3A3,$-0$" 63'( )#5+8
9)9"6&$ !" 6":0- 0"2'!"0$- )&*-./)0- , 2#6",$- ! 90$" DE #63'!0$" FGYD *J K L"*6" Z"2'!3'$-/" MN!J OJ ! DPFI *J 1)!J
FGF8 ! 15R0J !4JS8
9)'()93 2!3#&"0- ! 9!$"%"/0).'$ ;)#1)9"*'!-: 1*),"9!)0-: 0" 1)9#6",$- !-!,)/-0$" 0" 6-*-0$- #1-':"/0-: #6*->3
-&)0)4$'!0-: )&*-./)0-: , 1*!-1$#"'( ) #1-':"/03'( #6*->"'( -&)0)4$'!03'(8
-&,$,"/-063 1$-0$=A0- !" 9-126"63 ,=;/),- )&*-./)0- , 1*!-1$#"'( ) &)4-*':"/$!"':$8 *-#6*2&62*3!"':$ $ 1*3,"63!"':$
1*!-9#$=+$)*#6," 1"7#6,),-;) [C)/#&$- L)/-:- C"7#6,),-\8
-&,$,"/-063 ! 6362%2 1*"," 9) +-!1%"60-;) ,=;/" )&*-./)0- , 1*!-1$#"'( ) *-#6*2&62*3!"':$ ;5*0$'6," ,=;/"
&"4$-00-;) , /"6"'( DPPX DPPE8
.,$"9'!-0$" )&*-./)0- , 1*!-1$#"'( ) ,3&)03,"0$2 4"09"62 1)#%" $ #-0"6)*"8
9)'()93 2!3#&"0- ! ;)#1)9"*#6," *)/0-;)8
9)'()93 2!3#&$,"0- !" ;*"0$'< ?!-'!31)#1)/$6-: C)/#&$-:8 1)40$-:#!)0- )91),$-90$) ) !"1%"')0- !" ;*"0$'<
?!-'!31)#1)/$6-: C)/#&$-:] 1)9"6-& 9)'()9),3 )*"! #&%"9&$ 0" )+),$<!&),- 2+-!1$-'!-0$" #1)%-'!0- $ )+),$<!&),2+-!1$-'!-0$- !9*),)60-8
*-063 )&*-./)0- , 1*!-1$#"'( ) ,#1$-*"0$2 *)!,):2 )+#!"*5, ,$-:#&$'( !- .*)9&5, 1)'()9!<'3'( ! T-&':$ U,"*"0':$
^2*)1-:#&$-;) _2092#!2 W*$-06"':$ $ U,"*"0':$ ?)/0-: )*"! , 1*!-1$#"'( ) ,#1$-*"0$2 *)!,):2 )+#!"*5, ,$-:#&$'( !
29!$"%-4 .*)9&5, ^2*)1-:#&$-;) _2092#!2 ?)/0-;) 0" *!-'! ?)!,):2 W+#!"*5, `$-:#&$'(8
!"/$'!&= "/$4-06"'3:0< )&*-./)0< , 1*!-1$#"'( ) 1)#6=1),"0$2 ,)+-' 9%2A0$&5, "/$4-06"'3:03'( )*"! !"/$'!'"/$4-06"'3:0-:8
.,$"9'!-0$" 1$-0$=A0- ,31%"'"0- , 1*!31"9&2 +-!#&26-'!0).'$ -;!-&2':$ "/$4-065,8
1)4)' 4"6-*$"/0< ) '("*"&6-*!- #)':"/034 )&*-./)0< , "*6J GP' 2#6J D 2#6",3 ! 90$" H ,*!-.0$" FGGF *J ) #3#6-4$).,$"63 MN!J OJ ! DPFQ *J 1)!J DFQE8 ! 15R0J !4JS )*"! 1)4)' 4"6-*$"/0< )&*-./)0< , "*6J FHX 2#6J F 1&6 F8 D $ Y8 "*6J
!
!"#$%#&'(% ))%*+'(% %,-'% $%.%/%0%/%#&'(% ))#%*+'#12%3%45/#%.!%6/,7#%.889%&(% !"#$% % &'(%)*+,-$+. $/0&'/12
3 4$+#5,'.*+. 6+.*+70*. + 6%1%, 6+.*+70*8 %(".4)%*. $ 9&-#$+. ' 5*+# :; 1#",# :;<= "> % 5'+#?#,'#,@ %6%'/,A+
#*-/(%19*+&-/,'*.A %"#' %&%B#,@ ".6".&A%*%$#*/,@ ' 6%$%5C$ 6%)+-/,'*/,@ DE'> F> 6%'> GHI2 ' 6CJ*> '1>K2
3 ($%-/ %-"'/1#*. *# 6%5&-#$+. #"-> :LM 9&-> NO<; 9&-#$/ ' 5*+# :G )+6,# <HH< "> % 6%5#-(9 5%,@%5%$/1 %5 %&CB
M+'/,'*/,@2
3 4$+#5,'.*+. "%5'+,+.)&(+.2
3 '#&+?.( 1#,+."'/P&(+2 % (-C"/1 1%$# $ 6"'.6+&#,@ % 9B.'6+.,'.*+9 &6%?.,'*/1 "%)*+(C$>
Q-/6.*5+#2 % (-C"/,@ 1%$# $ 6%9,'.*+92 (-C". 6%$+**/ B/R $/(#'#*. A#(% 5%,@C5 *+.6%5).S#A8,/ %6%5#-(%$#*+92 -%
1>+*>T
<K &-/6.*5+# 5%(-%"#*,(+. + @#B+)+-#,/A*. 6"'/'*#*. *# 6%5&-#$+. 9&-#$/ ' 5*+# <U 1#",# :;;I "> % &-%6*+#,@
*#9(%$/,@ + -/-9). *#9(%$/1 %"#' % &-%6*+#,@ + -/-9). $ '#(".&+. &'-9(+V
:K 6"'/'*#*. *# 6%5&-#$+. 9&-#$/ ' 5*+# :L )+6,# :;;= "> !"#$% % &'(%)*+,-$+. $/0&'/1T
#K &-/6.*5+# 5%(-%"#*,(+.2 %(".4)%*. $ #"-> :;; $$> 9&-#$/2
BK &-/6.*5+# % ,@#"#(-."'. &%,A#)*/1 + '#6%1%S+2 -#(+. A#(T
3
&-/6.*5+# 5%-/,'8,. &-95.*-C$2 %(".4)%*. $ #"-> <LI 9&-> < 6(- <2 : + N $$> 9&-#$/2
3
&-/6.*5+# 5%-/,'8,. 5%(-%"#*-C$2 %(".4)%*. $ #"-> <HH 9&-> < 6(- <2 : + U $$> 9&-#$/2
3
6%1%, 1#-."+#)*# 5)# 5%(-%"#*-C$ 6"'/'*#$#*# 'S%5*+. ' #"-> <HH# $$> 9&-#$/ 6"'.' A.5*%&-(+
&#1%"'859 -."/-%"+#)*.S% *# '#&#5#,@ %(".4)%*/,@ $ #"-> <LI# $$> 9&-#$/V
IK &-/6.*5+# &6%"-%$. 6"'/'*#*. *# 6%5&-#$+. 9&-#$/ ' 5*+# := ,'."$,# :;<; "> % &6%",+.V
UK &-/6.*5+91 &'(%)*. %"#' '#&+?.( &'(%)*/2 -A> &-/6.*5+# 1#-."+#)*. % ,@#"#(-."'. &%,A#)*/12 $/*+(#A8,. ' 9&-#$/ '
5*+# L $"'.4*+# <HH< "> % &/&-.1+. %4$+#-/>
W4$+#5,'#12 0. '#6%'*#?#1X'#6%'*#?.1 &+7 ' 6%$/0&'/1 6%9,'.*+.1>
W4$+#5,'#12 0. A.&-.1 4$+#5%1/X4$+#5%1# %56%$+.5'+#)*%4,+ (#"*.A '# '?%0.*+. M#?&'/$.S%
%4$+#5,'.*+#>
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
D1+.A&,%$%4R2 5#-# + 6%56+& %&%B/ &(?#5#A8,.A %4$+#5,'.*+.K

Podobne dokumenty