Příloha x. 4 x xxxxxxxx x. 467/2003 Sb.
Xxxx xxxxxxxxx pro xxxxxxxx tabákových xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx x xxxxxxxxx xxxxxxxxxx nálepkách xx xxxxxxxx výrobky
1. Xxxxx xxxxxxxxx tabákových xxxxxxx
x) xxx xxxxxxxx
____________________________________________________________________________________________
Obsah xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: CELKEM:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx osoby pověřeného xxxxxxx xxxxx:
x) xxx xxxxxxxx x cigarillos
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx a xxxxxx xxxxxx osoby xxxxxxxxxx xxxxxxx xxxxx:
x) pro xxxxx xx xxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(kg)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx a podpis xxxxxx xxxxx pověřeného xxxxxxx xxxxx:
2. Xxxxx xxxxx xxxxxxxxxx nálepek xx xxxxxx na xxxxxxx xxxxx Xxxxx republiky
____________________________________________________________________________________________
Xxxxx vydání Xxxxx Xxxx xxx Počet tabákových xxxxxxx v xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx balení do výroby užitých
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet xxxxxxx: XXXXXX:
____________________________________________________________________________________________
3. Xxxxx xxxxx xxxxxxxxxx nálepek xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
Datum odeslání Obsah Xxxx xxx Počet xxxxxxxxxx xxxxxxx x xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx xxxxxxx xxxxxxxxxxx
xx balení daňové xxxxx xxxx xxxxxx xxxxx
xxxxxxx Xxxxx xxxxxxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx nálepek
____________________________________________________________________________________________
Datum Xxxxx Cena pro Xxxxx xxxxxxxxxx xxxxxxx x kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Datum: Razítko x xxxxxx
odběratele