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