Xxxxxxxx od 14.7.2005 xx 3.4.2007 (xx xxxxxx č. 72/2007 Xx.)
Xxxxxxx x. 4 x vyhlášce x. 467/2003 Sb.
Vzor tiskopisu xxx xxxxxxxx xxxxxxxxxx xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx x xxxxxxxxx xxxxxxxxxx xxxxxxxxx xx xxxxxxxx xxxxxxx
1. Výkaz xxxxxxxxx xxxxxxxxxx xxxxxxx
x) xxx xxxxxxxx
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Xxxxx balení Cena xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx úřadu:
b) xxx doutníky x xxxxxxxxxx
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Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxx
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Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx převzetí Jméno x xxxxxx xxxxxxxxxxx pověřeho xxxxxxx xxxxx:
2. Xxxxx xxxxx xxxxxxxxxx nálepek xx xxxxxx xx xxxxxxx xxxxx Xxxxx xxxxxxxxx
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Xxxxx vydání Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx do skutečně poškozených
za xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
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Xxxxx xxxxxxx: XXXXXX:
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3. Xxxxx xxxxx xxxxxxxxxx nálepek xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
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Xxxxx xxxxxxxx Xxxxx Xxxx pro Xxxxx xxxxxxxxxx nálepek x xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx xxxxxxx xxxxxxxxxxx
xx xxxxxx xxxxxx xxxxx mimo xxxxxx xxxxx
xxxxxxx Xxxxx xxxxxxxxx Xxxxx xxxxxxxxx
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Xxxxx xxxxxxx: XXXXXX:
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4. Xxxxx vrácených xxxxxxxxxxx xxxxxxxxxx nálepek
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Datum Xxxxx Cena xxx Počet tabákových xxxxxxx v kusech
vrácení balení konečného __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx balení
cigaret
____________________________________________________________________________________________
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Počet xxxxxxx: XXXXXX:
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Xxxxx: Xxxxxxx x podpis
odběratele