Xxxxxxx x. 4 x xxxxxxxx x. 467/2003 Xx.
Xxxx tiskopisu xxx xxxxxxxx tabákových nálepek
XXXXX
x xxxxxxxxx, xxxxxxx x xxxxxxxxx xxxxxxxxxx nálepkách xx xxxxxxxx xxxxxxx
1. Xxxxx xxxxxxxxx tabákových xxxxxxx
x) xxx xxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxx xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxx osoby xxxxxxxxxx xxxxxxx xxxxx:
x) pro xxxxxxxx x cigarillos
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: CELKEM:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x podpis xxxxxx osoby xxxxxxxxxx xxxxxxx úřadu:
x) pro xxxxx xx xxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Datum xxxxxxxx Xxxxx x xxxxxx xxxxxx xxxxx xxxxxxxxxx xxxxxxx xxxxx:
2. Xxxxx xxxxx xxxxxxxxxx nálepek ve xxxxxx xx xxxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Datum xxxxxx Xxxxx Cena xxx Xxxxx xxxxxxxxxx xxxxxxx v xxxxxx
xx výroby balení konečného __________________________________________
(xx, kg) spotřebitele vydaných xx xxxxxxxx xxxxxxxxxxx
xx xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
3. Xxxxx xxxxx xxxxxxxxxx xxxxxxx xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
Xxxxx odeslání Obsah Xxxx xxx Počet xxxxxxxxxx xxxxxxx x kusech
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx mimo skutečně xxxxxxx xxxxxxxxxxx
xx xxxxxx xxxxxx xxxxx mimo daňové xxxxx
cigaret České republiky České xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx vrácených xxxxxxxxxxx xxxxxxxxxx nálepek
____________________________________________________________________________________________
Xxxxx Xxxxx Xxxx pro Xxxxx xxxxxxxxxx xxxxxxx v xxxxxx
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(ks, xx) xxxxxxxxxxxx xxxxxxxxx celkem uznáno xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x podpis
xxxxxxxxxx