Xxxxxxxx xx 14.7.2005 xx 3.4.2007 (xx xxxxxx x. 72/2007 Xx.)
Xxxxxxx x. 4 x vyhlášce x. 467/2003 Sb.
Vzor xxxxxxxxx xxx evidenci xxxxxxxxxx xxxxxxx
XXXXX
x xxxxxxxxx, užitých x xxxxxxxxx xxxxxxxxxx xxxxxxxxx xx tabákové xxxxxxx
1. Výkaz přijatých xxxxxxxxxx xxxxxxx
x) pro xxxxxxxx
____________________________________________________________________________________________
Xxxxx balení Cena pro xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx úřadu:
b) xxx xxxxxxxx x xxxxxxxxxx
____________________________________________________________________________________________
Xxxxx balení Množství
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
x) pro xxxxx
____________________________________________________________________________________________
Xxxxx balení Množství
(kg)
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet položek: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
2. Xxxxx xxxxx tabákových xxxxxxx xx výrobě na xxxxxxx xxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Obsah Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx x kusech
do výroby balení konečného __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxx xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx výroby užitých
cigaret
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet xxxxxxx: XXXXXX:
____________________________________________________________________________________________
3. Xxxxx xxxxx xxxxxxxxxx xxxxxxx mimo xxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx nálepek v xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(ks, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx užitých poškozených
za xxxxxx xxxxxx xxxxx mimo xxxxxx xxxxx
xxxxxxx Xxxxx republiky České xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: CELKEM:
____________________________________________________________________________________________
4. Xxxxx vrácených xxxxxxxxxxx xxxxxxxxxx xxxxxxx
____________________________________________________________________________________________
Xxxxx Xxxxx Cena xxx Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, kg) spotřebitele vrácených xxxxxx xxxxxx xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x xxxxxx
xxxxxxxxxx