Xxxxxxx x. 4 x vyhlášce x. 467/2003 Sb.
Xxxx xxxxxxxxx xxx xxxxxxxx xxxxxxxxxx nálepek
XXXXX
o xxxxxxxxx, xxxxxxx x vrácených xxxxxxxxxx xxxxxxxxx na xxxxxxxx xxxxxxx
1. Xxxxx xxxxxxxxx tabákových xxxxxxx
a) pro xxxxxxxx
____________________________________________________________________________________________
Obsah xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx xx xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: CELKEM:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
x) pro doutníky x xxxxxxxxxx
____________________________________________________________________________________________
Xxxxx balení Množství
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxx xx xxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(kg)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxx osoby xxxxxxxxxx xxxxxxx xxxxx:
2. Výkaz užití xxxxxxxxxx nálepek xx xxxxxx na xxxxxxx xxxxx České republiky
____________________________________________________________________________________________
Datum xxxxxx Xxxxx Cena xxx Počet xxxxxxxxxx xxxxxxx x xxxxxx
xx výroby balení konečného __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx výroby užitých
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
3. Výkaz užití xxxxxxxxxx xxxxxxx mimo xxxxxx území České xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx Cena xxx Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx xxxxxxx xxxxxxxxxxx
xx xxxxxx xxxxxx xxxxx xxxx daňové xxxxx
cigaret České xxxxxxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet položek: XXXXXX:
____________________________________________________________________________________________
4. Výkaz xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxxx
____________________________________________________________________________________________
Xxxxx Xxxxx Xxxx xxx Xxxxx tabákových xxxxxxx x kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(ks, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx balení
cigaret
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Datum: Razítko x xxxxxx
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