Xxxxxxxx xx 14.7.2005 xx 3.4.2007 (xx xxxxxx x. 72/2007 Xx.)
Xxxxxxx x. 4 x xxxxxxxx x. 467/2003 Sb.
Vzor xxxxxxxxx xxx xxxxxxxx tabákových xxxxxxx
XXXXX
x xxxxxxxxx, xxxxxxx x vrácených tabákových xxxxxxxxx xx tabákové xxxxxxx
1. Xxxxx xxxxxxxxx xxxxxxxxxx xxxxxxx
x) xxx xxxxxxxx
____________________________________________________________________________________________
Xxxxx balení Cena xxx xxxxxxxxx Xxxxxxxx
(xx) xxxxxxxxxxxx za xxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
x) xxx doutníky x xxxxxxxxxx
____________________________________________________________________________________________
Xxxxx balení Množství
(ks)
____________________________________________________________________________________________
____________________________________________________________________________________________
Počet položek: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx a xxxxxx xxxxxxxxxxx xxxxxxxx xxxxxxx xxxxx:
x) xxx xxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxxxxx
(xx)
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx x xxxxxx zaměstnance xxxxxxxx xxxxxxx xxxxx:
2. Výkaz xxxxx xxxxxxxxxx xxxxxxx xx xxxxxx xx xxxxxxx xxxxx České xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxx Xxxxx Xxxx xxx Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xx xxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, kg) spotřebitele vydaných do skutečně poškozených
za xxxxxx xx xxxxxx xxxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
3. Xxxxx xxxxx xxxxxxxxxx xxxxxxx xxxx xxxxxx xxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
Xxxxx xxxxxxxx Xxxxx Xxxx xxx Počet xxxxxxxxxx nálepek v xxxxxx
xxxxxx xxxxxxxxx ________________________________________________
(xx, xx) xxxxxxxxxxxx xxxxxxxxx xxxx xxxxxxxx xxxxxxx xxxxxxxxxxx
xx xxxxxx xxxxxx území xxxx xxxxxx xxxxx
xxxxxxx Xxxxx xxxxxxxxx Xxxxx xxxxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx položek: XXXXXX:
____________________________________________________________________________________________
4. Xxxxx xxxxxxxxx poškozených xxxxxxxxxx xxxxxxx
____________________________________________________________________________________________
Xxxxx Xxxxx Cena pro Xxxxx xxxxxxxxxx xxxxxxx x xxxxxx
xxxxxxx xxxxxx xxxxxxxxx __________________________________________
(xx, kg) spotřebitele vrácených xxxxxx xxxxxx xxxxxxxx
xx xxxxxx
xxxxxxx
____________________________________________________________________________________________
____________________________________________________________________________________________
Xxxxx xxxxxxx: XXXXXX:
____________________________________________________________________________________________
Xxxxx: Xxxxxxx x podpis
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