Xxxxxxx č. 4 k vyhlášce x. 467/2003 Sb.
Xxxx tiskopisu xxx xxxxxxxx xxxxxxxxxx xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx a xxxxxxxxx xxxxxxxxxx xxxxxxxxx na xxxxxxxx xxxxxxx
1. Xxxxx xxxxxxxxx tabákových xxxxxxx
a) xxx xxxxxxxx
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Xxxxx xxxxxx Xxxx xxx konečného Množství
(xx) xxxxxxxxxxxx xx balení
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
x) pro doutníky x xxxxxxxxxx
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Xxxxx balení Množství
(xx)
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Xxxxx položek: XXXXXX:
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Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
x) pro xxxxx xx xxxxxxx
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Xxxxx balení Množství
(xx)
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Xxxxx xxxxxxx: CELKEM:
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Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
2. Xxxxx užití xxxxxxxxxx xxxxxxx ve xxxxxx na daňovém xxxxx Xxxxx republiky
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Xxxxx xxxxxx Xxxxx Cena pro Xxxxx xxxxxxxxxx xxxxxxx x kusech
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx do skutečně poškozených
xx xxxxxx xx výroby užitých
xxxxxxx
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Počet xxxxxxx: XXXXXX:
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3. Xxxxx xxxxx xxxxxxxxxx nálepek xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
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Datum xxxxxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx v xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx xxxxxxx xxxxxxxxxxx
xx xxxxxx xxxxxx xxxxx mimo xxxxxx xxxxx
cigaret České xxxxxxxxx Xxxxx xxxxxxxxx
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Počet položek: XXXXXX:
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4. Výkaz vrácených xxxxxxxxxxx xxxxxxxxxx xxxxxxx
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Xxxxx Xxxxx Xxxx pro Počet xxxxxxxxxx xxxxxxx x kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx xxxxxx
xxxxxxx
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Xxxxx xxxxxxx: CELKEM:
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Datum: Razítko x podpis
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