Xxxxxxx č. 4 k xxxxxxxx x. 467/2003 Xx.
Xxxx tiskopisu xxx xxxxxxxx xxxxxxxxxx xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx a vrácených xxxxxxxxxx nálepkách na xxxxxxxx výrobky
1. Xxxxx přijatých tabákových xxxxxxx
a) xxx xxxxxxxx
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Xxxxx xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx xx xxxxxx
____________________________________________________________________________________________
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Xxxxx položek: XXXXXX:
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Datum xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
x) xxx xxxxxxxx x xxxxxxxxxx
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Xxxxx xxxxxx Xxxxxxxx
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx xxxxx pověřeného xxxxxxx úřadu:
x) pro xxxxx xx xxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(kg)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx pověřeného xxxxxxx xxxxx:
2. Výkaz užití xxxxxxxxxx xxxxxxx ve xxxxxx na daňovém xxxxx Xxxxx xxxxxxxxx
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Datum vydání Xxxxx Xxxx pro Xxxxx xxxxxxxxxx xxxxxxx v xxxxxx
xx výroby balení konečného __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
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Počet položek: XXXXXX:
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3. Xxxxx xxxxx xxxxxxxxxx nálepek mimo xxxxxx xxxxx Xxxxx xxxxxxxxx
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Xxxxx xxxxxxxx Xxxxx Xxxx xxx Xxxxx tabákových xxxxxxx x xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx mimo skutečně xxxxxxx xxxxxxxxxxx
xx xxxxxx xxxxxx xxxxx xxxx xxxxxx xxxxx
cigaret České xxxxxxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
4. Výkaz xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxxx
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Xxxxx Xxxxx Cena xxx Xxxxx tabákových xxxxxxx v kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx celkem uznáno xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx: Xxxxxxx x podpis
xxxxxxxxxx