Xxxxxxx x. 4 k xxxxxxxx x. 467/2003 Xx.
Xxxx xxxxxxxxx pro xxxxxxxx xxxxxxxxxx nálepek
XXXXX
o xxxxxxxxx, xxxxxxx x xxxxxxxxx xxxxxxxxxx nálepkách na xxxxxxxx výrobky
1. Xxxxx xxxxxxxxx xxxxxxxxxx xxxxxxx
x) xxx xxxxxxxx
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Xxxxx xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
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Xxxxx položek: XXXXXX:
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Datum xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
x) xxx doutníky x xxxxxxxxxx
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Xxxxx xxxxxx Xxxxxxxx
(xx)
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Xxxxx xxxxxxx: CELKEM:
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Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx pověřeného xxxxxxx úřadu:
x) xxx xxxxx xx kouření
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Xxxxx balení Množství
(xx)
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Xxxxx xxxxxxx: XXXXXX:
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Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx pověřeného xxxxxxx úřadu:
2. Výkaz xxxxx xxxxxxxxxx xxxxxxx xx xxxxxx xx xxxxxxx xxxxx Xxxxx xxxxxxxxx
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Xxxxx xxxxxx Xxxxx Xxxx xxx Xxxxx tabákových xxxxxxx x xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx balení do xxxxxx xxxxxxx
xxxxxxx
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Xxxxx xxxxxxx: XXXXXX:
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3. Výkaz užití xxxxxxxxxx xxxxxxx xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
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Xxxxx xxxxxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx v xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx užitých xxxxxxxxxxx
xx balení daňové xxxxx xxxx daňové xxxxx
cigaret České xxxxxxxxx Xxxxx xxxxxxxxx
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Počet položek: XXXXXX:
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4. Xxxxx xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxxx
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Xxxxx Xxxxx Cena xxx Xxxxx tabákových xxxxxxx x kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(ks, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx xxxxxx
xxxxxxx
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Xxxxx položek: XXXXXX:
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Datum: Razítko x xxxxxx
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