Příloha č. 4 x xxxxxxxx x. 467/2003 Sb.
Xxxx tiskopisu pro xxxxxxxx tabákových nálepek
XXXXX
x xxxxxxxxx, xxxxxxx x xxxxxxxxx xxxxxxxxxx xxxxxxxxx xx xxxxxxxx xxxxxxx
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 xxxxxxx: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx osoby xxxxxxxxxx xxxxxxx xxxxx:
x) xxx doutníky x cigarillos
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Xxxxx xxxxxx Xxxxxxxx
(xx)
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Xxxxx položek: CELKEM:
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Datum xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
x) xxx xxxxx xx xxxxxxx
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Xxxxx xxxxxx Xxxxxxxx
(xx)
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
2. Výkaz xxxxx xxxxxxxxxx nálepek ve xxxxxx na daňovém xxxxx České xxxxxxxxx
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Xxxxx xxxxxx Xxxxx Xxxx pro Počet tabákových xxxxxxx x xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, kg) spotřebitele vydaných xx xxxxxxxx xxxxxxxxxxx
xx balení do xxxxxx xxxxxxx
xxxxxxx
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Xxxxx položek: XXXXXX:
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3. Xxxxx xxxxx xxxxxxxxxx xxxxxxx mimo xxxxxx území Xxxxx xxxxxxxxx
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Xxxxx xxxxxxxx Xxxxx Xxxx xxx Počet xxxxxxxxxx xxxxxxx v xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx mimo skutečně užitých xxxxxxxxxxx
xx balení daňové xxxxx xxxx xxxxxx xxxxx
cigaret České xxxxxxxxx Xxxxx xxxxxxxxx
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Počet xxxxxxx: XXXXXX:
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4. Výkaz xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxxx
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Datum Xxxxx Xxxx pro Xxxxx tabákových xxxxxxx x xxxxxx
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx balení
xxxxxxx
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx: Xxxxxxx x xxxxxx
xxxxxxxxxx