Xxxxxxx x. 4 x xxxxxxxx x. 467/2003 Xx.
Xxxx xxxxxxxxx xxx xxxxxxxx tabákových nálepek
XXXXX
x přijatých, xxxxxxx a vrácených xxxxxxxxxx xxxxxxxxx xx xxxxxxxx xxxxxxx
1. Xxxxx přijatých xxxxxxxxxx xxxxxxx
a) xxx xxxxxxxx
____________________________________________________________________________________________
Obsah xxxxxx Xxxx pro xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx xx balení
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxxxxx x cigarillos
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx osoby xxxxxxxxxx xxxxxxx úřadu:
x) pro xxxxx xx xxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
2. Xxxxx xxxxx xxxxxxxxxx xxxxxxx xx xxxxxx xx xxxxxxx xxxxx Xxxxx republiky
____________________________________________________________________________________________
Xxxxx vydání Xxxxx Cena xxx Počet xxxxxxxxxx xxxxxxx x xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
3. Xxxxx xxxxx xxxxxxxxxx xxxxxxx xxxx xxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx Cena xxx Xxxxx tabákových xxxxxxx x xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx mimo skutečně xxxxxxx xxxxxxxxxxx
xx balení daňové xxxxx xxxx xxxxxx xxxxx
xxxxxxx Xxxxx republiky České xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet položek: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx vrácených xxxxxxxxxxx xxxxxxxxxx xxxxxxx
____________________________________________________________________________________________
Xxxxx Xxxxx Xxxx xxx Xxxxx tabákových xxxxxxx x kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx neuznáno
xx xxxxxx
cigaret
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: CELKEM:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x podpis
odběratele