Příloha č. 4 x xxxxxxxx x. 467/2003 Sb.
Xxxx tiskopisu xxx xxxxxxxx xxxxxxxxxx nálepek
XXXXX
o xxxxxxxxx, xxxxxxx x xxxxxxxxx xxxxxxxxxx xxxxxxxxx xx xxxxxxxx výrobky
1. Xxxxx přijatých xxxxxxxxxx xxxxxxx
a) pro xxxxxxxx
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Xxxxx xxxxxx Xxxx pro xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx xx xxxxxx
____________________________________________________________________________________________
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Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxxxxx x cigarillos
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: CELKEM:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx osoby xxxxxxxxxx xxxxxxx úřadu:
x) xxx tabák xx xxxxxxx
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Xxxxx xxxxxx Xxxxxxxx
(kg)
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Xxxxx xxxxxxx: XXXXXX:
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Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx osoby xxxxxxxxxx xxxxxxx xxxxx:
2. Výkaz xxxxx xxxxxxxxxx xxxxxxx xx xxxxxx xx xxxxxxx xxxxx Xxxxx republiky
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Xxxxx vydání Xxxxx Xxxx xxx Počet xxxxxxxxxx xxxxxxx x xxxxxx
xx výroby balení konečného __________________________________________
(xx, kg) spotřebitele vydaných xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
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Xxxxx xxxxxxx: XXXXXX:
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3. Xxxxx xxxxx xxxxxxxxxx nálepek mimo xxxxxx xxxxx České xxxxxxxxx
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Xxxxx xxxxxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx x kusech
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx užitých xxxxxxxxxxx
za xxxxxx xxxxxx xxxxx xxxx xxxxxx xxxxx
cigaret České republiky České xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx xxxxxxxxx xxxxxxxxxxx xxxxxxxxxx nálepek
____________________________________________________________________________________________
Xxxxx Xxxxx Xxxx xxx Počet xxxxxxxxxx xxxxxxx v kusech
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(ks, xx) xxxxxxxxxxxx xxxxxxxxx xxxxxx xxxxxx xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: CELKEM:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x xxxxxx
xxxxxxxxxx