Xxxxxxx x. 4 x xxxxxxxx x. 467/2003 Xx.
Xxxx xxxxxxxxx xxx xxxxxxxx xxxxxxxxxx xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx x vrácených xxxxxxxxxx nálepkách xx xxxxxxxx xxxxxxx
1. Xxxxx xxxxxxxxx xxxxxxxxxx xxxxxxx
x) pro xxxxxxxx
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Xxxxx xxxxxx Xxxx xxx konečného Množství
(xx) xxxxxxxxxxxx za xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a podpis xxxxxx xxxxx pověřeného xxxxxxx xxxxx:
x) xxx doutníky x xxxxxxxxxx
____________________________________________________________________________________________
Xxxxx balení Množství
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: CELKEM:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxx xx kouření
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: CELKEM:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxx osoby pověřeného xxxxxxx xxxxx:
2. Xxxxx užití xxxxxxxxxx xxxxxxx xx xxxxxx xx daňovém xxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
Xxxxx vydání Xxxxx Xxxx xxx Xxxxx tabákových xxxxxxx x kusech
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx do skutečně poškozených
xx xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
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3. Výkaz užití xxxxxxxxxx xxxxxxx xxxx xxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx užitých xxxxxxxxxxx
za xxxxxx xxxxxx xxxxx mimo daňové xxxxx
xxxxxxx Xxxxx xxxxxxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx vrácených xxxxxxxxxxx xxxxxxxxxx nálepek
____________________________________________________________________________________________
Xxxxx Xxxxx Cena xxx Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx neuznáno
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x podpis
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