ÂÕ. ¹ _____________________                                                 ÄÎ

                                                                                                          ÊÌÅÒÀ

                                                                                                          ÍÀ ÎÁÙÈÍÀ ÏÚÐÂÎÌÀÉ

 

Ä Å Ê Ë À Ð À Ö È ß 

       ÇÀ ÎÑÂÎÁÎÆÄÀÂÀÍÅ ÎÒ ÑÌÅÒÎÑÚÁÈÐÀÍÅ È ÑÌÅÒÎÈÇÂÎÇÂÀÍÅ

Íà îñíîâàíèå ÷ë.19, àë.2 îò ÍÎÀÌÒÖÓ 

 

 

Ïðåäñòàâëÿâàíî îò Ñ1……………………………………………………...     ÅÃͅ…………………………

                                                                    /òðèòå èìåíà/

Àäðåñ: ãð./ñ. ……………………….., óë. ………………………………..., ¹ ……, âõ…….., åò….., à;

            îáù…………………………..., îá녅…………………………….; 

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 È. Ñ2…………………………………………………………………………...ÅÃͅ…………………….…….

                                                                      /òðèòå èìåíà/

 Àäðåñ: ãð./ñ. …………………… .., óë. …………………………………...., ¹ ……, âõ…….., åò….., à;

            îáù…………………………..., îá녅…………………………….;  

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 È Ñ3…………………………………………………………………………...ÅÃͅ…………………….…….

                                                                      /òðèòå èìåíà/

Àäðåñ: ãð./ñ. …………………….., óë. …………………………………….., ¹ ……, âõ…….., åò….., à;

            îáù…………………………..., îá녅…………………………….; 

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 È  Ñ4. ………………………………………………………………………….ÅÃͅ…………………….…….

                                                                      /òðèòå èìåíà/ 

Àäðåñ: ãð./ñ. …………………....., óë. ……………………………………..., ¹ ……, âõ…….., åò….., à;

            îáù…………………………..., îá녅…………………………….;  

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 È ÏÎËÇÂÀÒÅË 1…………………………………………………………….ÅÃͅ…………………….…….

Àäðåñ: ãð./ñ. …………………....., óë. ……………………………………..., ¹ ……, âõ…….., åò….., à;

            îáù…………………………..., îá녅…………………………….;  

 

  ÏÎËÇÂÀÒÅË 2…………………………………………………………….ÅÃͅ…………………….…….

                                                                      /òðèòå èìåíà/ 

Àäðåñ: ãð./ñ. …………………....., óë. ……………………………………..., ¹ ……, âõ…….., åò….., à;

            îáù…………………………..., îá녅…………………………….;  

 

Óâàæàåìè ã-í Êìåò,

 

 Äåêëàðèðàìå â êà÷åñòâîòî ñè íà äàíú÷íîçàäúëæåíî/è ëèöå/à, ÷å èìîò ñ ïàðòèäåí ¹……………………..,  

ïðåäñòàâëÿâàù……………………………………………………………………………………………………, 

íàõîäÿù ñå íà àäðåñ: ãð./ñ. …………   ……………., óë. ……………………………,……………. ¹ ………..,

âõ……..,  åò……., à…;     îáù………   …………………......., îá녅………………………………….., 

íÿìà äà ñå ïîëçâà ïðåç öÿëàòà……………………..ãîäèíà.

 

  Äàòà…………………………..      Ïîäïèñè íà äåêëàðàòîðèòå:      1.……………………………

                                                                                                                      2………………………………

                                                                                                                      3………………………………

                                                                                                                      4………………………………