Příloha x. 4 x xxxxxxxx x. 467/2003 Sb.
Xxxx tiskopisu xxx xxxxxxxx xxxxxxxxxx xxxxxxx
XXXXX
x přijatých, xxxxxxx a xxxxxxxxx xxxxxxxxxx xxxxxxxxx xx xxxxxxxx xxxxxxx
1. Xxxxx xxxxxxxxx tabákových xxxxxxx
x) pro xxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx xx xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: CELKEM:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx osoby pověřeného xxxxxxx xxxxx:
x) xxx doutníky x xxxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxx xxxxx pověřeného xxxxxxx xxxxx:
x) pro tabák xx xxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(kg)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx úřadu:
2. Xxxxx xxxxx xxxxxxxxxx xxxxxxx ve xxxxxx xx daňovém xxxxx Xxxxx republiky
____________________________________________________________________________________________
Datum xxxxxx Xxxxx Cena xxx Počet xxxxxxxxxx xxxxxxx v kusech
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, kg) spotřebitele vydaných xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
3. Xxxxx xxxxx xxxxxxxxxx xxxxxxx xxxx xxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx Cena xxx Počet xxxxxxxxxx xxxxxxx v kusech
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx užitých xxxxxxxxxxx
xx xxxxxx xxxxxx xxxxx xxxx xxxxxx xxxxx
xxxxxxx Xxxxx xxxxxxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet položek: XXXXXX:
____________________________________________________________________________________________
4. Výkaz xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxxx
____________________________________________________________________________________________
Xxxxx Xxxxx Cena pro Xxxxx xxxxxxxxxx xxxxxxx v kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx celkem uznáno xxxxxxxx
xx balení
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x xxxxxx
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