HP NG S : ........

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
______________________________

HP NG CHUYN I QUYN S DNG T 1

I. PHN GHI CA CC BN CHUYN I
1. ng (B): ....................................................................sinh nm.......................
- Chng minh nhn dn s:....................................... do:......................................
cp ngy..thngnm..................................
- Ngh nghip:.....................................................................................................
- a ch thng tr:..............................................................................................

- Din tch t chuyn i:..............................................................................m2

- Loi t:................................................Hng t (nu c) ...............................
- Tha s:. ...........................................................................................................
- T bn s:....................................................................................................
- Thi hn s dng t cn li:............................................................................
- Giy chng nhn quyn s dng t s:..............do..........................................
cp ngy............... thng ............... nm .............................................................
2.
ng
(B):
......................................................................
sinh
nm......................
- Chng minh nhn dn s:.................. ..do:.....................................
cp ngy..................thng.nm....................................................
- Ngh nghip:.....................................................................................................
- a ch thng tr:..............................................................................................
.
- Din tch t chuyn i:..............................................................................m2
- Loi t:................................................Hng t (nu c) ...............................
- Tha s:. ...........................................................................................................
- T bn s:....................................................................................................
- Thi hn s dng t cn li:............................................................................
- Giy chng nhn quyn s dng t s:..............do..........................................
cp ngy............... thng ............... nm .............................................................
3. Hai bn nht tr thc hin cc cam kt sau y :
a) Hai bn nht tr chuyn i cc tha t m t ti im 1, im 2 Phn I
hp ng ny.
b) Chuyn t cho nhau theo ng din tch, ng hin trng, ng thi gian
v y h s c lin quan n tha t.

c) Np y tin s dng t, l ph trc b ghi n trc y (nu c), l ph a

chnh, thu chuyn quyn s dng (nu c).
d) Bn no khng thc hin y nhng ni dung k kt trong bn hp ng
ny do li ca mnh th bn phi bi thng thit hi do li gy ra theo quy nh ca
php lut.
4. Quyn ca bn th ba i vi tha t chuyn i (nu c):.......................
...............................................................................................................................
...............................................................................................................................
5. Tha thun v ti sn gn lin vi tha t chuyn i (nu c).................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
Hp ng ny lp ti ...................ngy.... thng.... nm ...... thnh ........ bn v c gi
tr nh nhau, c hiu lc k t ngy c y ban nhn dn cp c thm quyn di y xc
nhn.
I DIN CC BN CHUYN I
(k v ghi r h tn)

II. PHN GHI CA C QUAN NH NC

1. Ni dung xc nhn ca y ban nhn dn x, phng, th trn ni c t chuyn i:
- V giy t s dng:........................................................................................................
. .........................................................................................................................................
- V hin trng tha t:...................................................................................................
Ch s dng t:...............................................................................................................
Loi t:............................................................................................................................
Din tch:...........................................................................................................................
Thuc t bn s:...........................................................................................................
S tha t:.......................................................................................................................
t s dng n nh, khng c tranh chp:......................................................................
. .........................................................................................................................................
- V iu kin chuyn i: Thuc trng hp c chuyn i theo quy nh ti iu 5
ca Ngh nh s 17/1999/N-CP ngy 29 thng 3 nm 1999 ca Chnh ph.
Ngy . . . . thng . . . . nm . . .
TM. Y BAN NHN DN ............
(ghi r h tn, k v ng du)

2. Ni dung xc nhn ca c quan a chnh cp huyn ni c t chuyn i:

- V giy t s dng:........................................................................................................
. .........................................................................................................................................
- V hin trng tha t:...................................................................................................
Ch s dng t:...............................................................................................................
Loi t:............................................................................................................................
Din tch:...........................................................................................................................
Thuc t bn s:...........................................................................................................
S tha t:.......................................................................................................................
t s dng n nh, khng c tranh chp:......................................................................
. .........................................................................................................................................
- V iu kin chuyn i: Thuc trng hp c chuyn i theo quy nh ti iu 5
ca Ngh nh s 17/1999/N-CP ngy 29 thng 3 nm 1999 ca Chnh ph.
Ngy ... thng .... nm
C QUAN A CHNH CP HUYN
(ghi r h tn, k v ng du)

Ngy . . . . thng . . . . nm . . .
TM. U BAN NHN DN ............
(ghi r h tn, k v ng du)

Ghi ch: Trng hp chuyn i quyn s dng t ti nng thn th xc nhn vo mc 1

Trng hp chuyn i quyn s dng t ti th th xc nhn vo mc 1,2.

Mu ny c ban hnh km theo Quyt nh s:___/2004/Q-UB ngy __/___/ 2004 ca y ban nhn dn thnh ph.