Äîäàòîê 15

äî ïï. 4.15.2

 

 

 

Çàïîð³çüêà îáëàñíà

äåðæàâíà àäì³í³ñòðàö³ÿ

 

„___” _____________ 20    ð.

 

ì. Çàïîð³ææÿ

 

ÏÎѲÄ×ÅÍÍß ÏÐΠ²ÄÐßÄÆÅÍÍß ¹ ____________________

 

_________________________________________________________

(ïð³çâèùå, ³ì’ÿ, ïî áàòüêîâ³)

 

_________________________________________________________

(ïîñàäà, ì³ñöå ðîáîòè)

 

Êîìàíäèðîâàíîìó â _______________________________________

(ïóíêòè  ïðèçíà÷åííÿ)

_________________________________________________________

_________________________________________________________

_________________________________________________________

 

äëÿ _________________________________________________________________________________________________

(ìåòà â³äðÿäæåííÿ)

 

íà _______________________________ äí³â

 

                                               ijéñíî çà ïðåä’ÿâëåííÿì ïàñïîðòà

 

                      

Ì. Ï.

Êåð³âíèê  ________________________________________________

(ï³äïèñ)

 

„______”  ______________________ 200     ð.

 

 

 

 

 

Ïðèáóâ ó ________________________________________

 

„____” __________________   200   ð.

 

Ïå÷àòêà, ï³äïèñ __________________________________

                            __________________________________

 

 

Âèáóâ ç _________________________________________

 

„____” __________________ 200   ð.

 

Ïå÷àòêà, ï³äïèñ __________________________________

                            __________________________________

 

Ïðèáóâ ó ________________________________________

 

„____” __________________   200   ð.

 

Ïå÷àòêà, ï³äïèñ __________________________________

                            __________________________________

 

 

 

Âèáóâ ç _________________________________________

 

„____” __________________ 200   ð.

 

Ïå÷àòêà, ï³äïèñ __________________________________

                            __________________________________

 

Ïðèáóâ ó ________________________________________

 

„____” __________________   200   ð.

 

Ïå÷àòêà, ï³äïèñ __________________________________

                            __________________________________

 

 

 

Âèáóâ ç _________________________________________

 

„____” __________________ 200   ð.

 

Ïå÷àòêà, ï³äïèñ __________________________________

                            __________________________________

 

 

 

ÏÐÈ̲ÒÊÀ: ïðè âè¿çä³ äî äåê³ëüêîõ ïóíêò³â â³äì³òêè ïðî ïðèáóòòÿ ðîáëÿòüñÿ îêðåìî â êîæíîìó ç íèõ.