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}{\info{\title 20}{\doccomm ZNAKI:7505}{\author Dominik_Krus}{\creatim\yr2013\mo3\dy1\hr12\min3}{\author erdmannj}{\revtim\yr2013\mo3\dy1\hr12\min3}{\printim\yr0\mo0\dy0\hr0\min0}{\comment OpenOffice.org}{\vern3410}}\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708\deftab708

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}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\li210\ri0\lin210\rin0\fi-210\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
20. ADRES DOTYCHCZASOWEGO MIEJSCA POBYTU STA\'a3EGO }{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
(w przypadku braku miejsca pobytu sta\'b3ego nale\'bfy\line poda\'e6 ostatnie miejsce pobytu sta\'b3ego, a w przypadku braku ostatniego miejsca pobytu sta\'b3ego pole \line pozostawia si\'ea niewype\'b3nione)}\cell\row\trowd\trql\trleft0\ltrrow\trrh278\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalb\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalb\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\sb0\sa40\ltrpar{\b\hich\af4\dbch\af4\afs16\ab\rtlch \ltrch\loch\fs16\loch\f4
ZG\'a3OSZENIE POBYTU STA\'a3EGO}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}\cell\row\trowd\trql\trleft0\ltrrow\trrh230\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
Zg\'b3oszenie nale\'bfy wype\'b3ni\'e6 komputerowo (maszynowo) lub pismem odr\'eacznym, czytelnie, drukowanymi }
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literami.}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\sb0\sa120\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(MIEJSCOWO\'8c\'c6 \'96 DZIELNICA,  GMINA, WOJEW\'d3DZTWO,  KOD POCZTOWY)}
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..................................................................................................................................................................................................}\cell\row\trowd\trql\trleft0\ltrrow\trrh113\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalb\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\ul\ulc0\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
CZ\'ca\'8c\'c6 I}{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
 \'96 DANE DO ZAMELDOWANIA }{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
(wype\'b3nia osoba dokonuj\'b9ca zg\'b3oszenia pobytu sta\'b3ego)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(ULICA, NUMER DOMU, NUMER LOKALU)}\cell\row\trowd\trql\trleft0\ltrrow\trrh109\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa60\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh164\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clvertalb\cellx4678\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalb\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
1. NUMER PESEL}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li57\ri0\lin57\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
2. P\'a3E\'c6 }{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
(zaznaczy\'e6 w\'b3a\'9cciwe)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
21. ADRES NOWEGO MIEJSCA POBYTU STA\'a3EGO}\cell\row\trowd\trql\trleft0\ltrrow\trrh189\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx239\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx519\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx800\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx1080\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx1360\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx1640\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx1920\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx2200\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx2480\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx2760\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx3040\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx5024\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx5318\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx5919\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx6227\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs16\rtlch \ltrch\loch\fs16\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs2\rtlch \ltrch\loch\fs2\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
K}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs2\rtlch \ltrch\loch\fs2\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
M}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs2\rtlch \ltrch\loch\fs2\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs2\rtlch \ltrch\loch\fs2\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\qc\li210\ri0\lin210\rin0\fi-210\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(MIEJSCOWO\'8c\'c6 \'96 DZIELNICA, GMINA, WOJEW\'d3DZTWO,  KOD POCZTOWY)}\cell\row\trowd\trql\trleft0\ltrrow\trrh160\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sb160\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(ULICA, NUMER DOMU, NUMER LOKALU)}\cell\row\trowd\trql\trleft0\ltrrow\trrh187\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
3. NAZWISKO ..........................................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh97\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalc\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
4. IMI\'ca PIERWSZE ..................................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
Stwierdzam, \'bfe wy\'bfej wymieniona osoba przebywa pod wskazanym adresem}\cell\row\trowd\trql\trleft0\ltrrow\trrh60\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh236\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
5. KOLEJNE IMIONA ..............................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qj\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\qj\li182\ri0\lin182\rin0\fi0\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs9\ab\rtlch \ltrch\loch\fs9\loch\f4
NAZWISKO I IMI\'ca                                                                               RODZAJ, SERIA I NUMER DOKUMENTU STWIERDZAJ\'a5CEGO TO\'afSAMO\'8c\'c6}\cell\row\trowd\trql\trleft0\ltrrow\trrh109\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh136\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx10121\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
6. NAZWISKO RODOWE ........................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
......................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
.................................................................................................}\cell\row\trowd\trql\trleft0\ltrrow\trrh158\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx10121\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\qj\li137\ri0\lin137\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
(miejscowo\'9c\'e6, data)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\li56\ri0\lin56\rin0\fi0\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
(w\'b3asnor\'eaczny, czytelny podpis w\'b3a\'9cciciela lokalu lub innego podmiotu}\cell\row\trowd\trql\trleft0\ltrrow\trrh123\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx10121\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
7. NAZWISKA POPRZEDNIE ..................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\li700\ri0\lin700\rin0\fi0\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
dysponuj\'b9cego tytu\'b3em prawnym do lokalu)}\cell\row\trowd\trql\trleft0\ltrrow\trrh154\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh235\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalc\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
8. IMIONA POPRZEDNIE ........................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
Stwierdzam wiarygodno\'9c\'e6 powy\'bfszych danych}\cell\row\trowd\trql\trleft0\ltrrow\trrh125\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx9540\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qj\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
......................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qj\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
............................................................................................................................}\cell\row\trowd\trql\trleft0\ltrrow\trrh259\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\cellx3238\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx9540\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
9. IMI\'ca OJCA .................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
10. NAZWISKO RODOWE OJCA .............................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li139\ri0\lin139\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
(miejscowo\'9c\'e6, data)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
(w\'b3asnor\'eaczny, czytelny podpis osoby zg\'b3aszaj\'b9cej pobyt sta\'b3y, a w przypadku Pe\'b3nomocnika}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\fs10\loch\f4
\'96  }{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
seria i numer dokumentu stwierdzaj\'b9cego jego to\'bfsamo\'9c\'e6)}\cell\row\trowd\trql\trleft0\ltrrow\trrh95\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\cellx3238\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
11. IMI\'ca MATKI ..............................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
12. NAZWISKO RODOWE MATKI ............................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\li0\ri0\lin0\rin0\fi4\sb40\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh199\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\cellx3238\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\sb0\sa60\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\sb0\sa60\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qj\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\fs12\loch\f4
  }\cell\row\trowd\trql\trleft0\ltrrow\trrh81\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li112\ri0\lin112\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
13. DATA URODZENIA (dzie\'f1-miesi\'b9c-rok)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\ul\ulc0\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
CZ\'ca\'8c\'c6 II}{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
 \'96 ADRES / ADRESY, Z KT\'d3RYCH MA NAST\'a5PI\'c6 WYMELDOWANIE }{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
(wype\'b3nia osoba dokonuj\'b9ca}\cell\row\trowd\trql\trleft0\ltrrow\trrh221\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw1\brdrcf1\cellx125\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx344\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx572\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx800\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx1028\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx1256\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx1486\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx1715\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx1943\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx2171\clbrdrt\brdrs\brdrw1\brdrcf1\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\clvertalc\cellx2399\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\sb0\sa60\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
-}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\sb0\sa60\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
-}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qc\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\li653\ri0\lin653\rin0\fi0\sb40\sa0\ltrpar{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
zg\'b3oszenia pobytu sta\'b3ego z wymeldowaniem z dotychczasowego miejsca pobytu)}\cell\row\trowd\trql\trleft0\ltrrow\trrh150\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalc\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\sb120\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
14. MIEJSCE URODZENIA (nazwa miejscowo\'9cci) ...............................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\li9\ri0\lin9\rin0\fi0\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
ADRES MIEJSCA POBYTU STA\'a3EGO }{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
(wype\'b3ni\'e6 w\'b3a\'9cciwe)}\cell\row\trowd\trql\trleft0\ltrrow\trrh226\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
15. OBYWATELSTWO ............................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb80\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
.................................................................................................................................................................................................}\cell\row\trowd\trql\trleft0\ltrrow\trrh230\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\sb0\sa60\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
16. STAN CYWILNY }{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
(}{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
zaznaczy\'e6 w\'b3a\'9cciwe}{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(MIEJSCOWO\'8c\'c6 \'96 DZIELNICA, GMINA, WOJEW\'d3DZTWO, KOD POCZTOWY)}\cell\row\trowd\trql\trleft0\ltrrow\trrh151\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\cellx809\cellx1471\cellx2178\cellx2934\cellx3802\cellx4492\cellx5569\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalb\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
1. kawaler}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
2. panna}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
3. \'bfonaty}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
4. zam\'ea\'bfna}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
5. wdowiec}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
6. wdowa}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
7. rozwiedziony}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
8. rozwiedziona}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
.................................................................................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs9\rtlch \ltrch\loch\fs9\loch\f4
(ULICA, NUMER DOMU, NUMER LOKALU)}\cell\row\trowd\trql\trleft0\ltrrow\trrh326\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalb\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\sb80\sa40\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
17. IMI\'ca I NAZWISKO MA\'a3\'afONKA ORAZ JEGO NAZWISKO RODOWE }{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
(wype\'b3nia osoba pozostaj\'b9ca w zwi\'b9zku }
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li308\ri0\lin308\rin0\fi0\ltrpar{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
ma\'b3\'bfe\'f1skim)}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li9\ri0\lin9\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
ADRES MIEJSCA POBYTU CZASOWEGO TRWAJ\'a5CEGO PONAD 3 MIESI\'a5CE}{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
 (wype\'b3ni\'e6 w\'b3a\'9cciwe)}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li9\ri0\lin9\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
.................................................................................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\sl276\slmult1\qc\li9\ri0\lin9\rin0\fi0\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(MIEJSCOWO\'8c\'c6 \'96 DZIELNICA, GMINA, WOJEW\'d3DZTWO, KOD POCZTOWY)}\cell\row\trowd\trql\trleft0\ltrrow\trrh163\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li113\ri0\lin113\rin0\fi0\sb80\sa40\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
18. DOKUMENT STWIERDZAJ\'a5CY TO\'afSAMO\'8c\'c6 ..............................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li9\ri0\lin9\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
.................................................................................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(ULICA, NUMER DOMU, NUMER LOKALU)}\cell\row\trowd\trql\trleft0\ltrrow\trrh82\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalb\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalb\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li112\ri0\lin112\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qr\sb40\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\expnd-1\expndtw-8\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh63\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\qc\li0\ri273\lin0\rin273\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(RODZAJ, SERIA I NUMER DOKUMENTU, OZNACZENIE ORGANU WYDAJ\'a5CEGO DOKUMENT ORAZ DATA JEGO WA\'afNO\'8cCI)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\expnd0\expndtw-2\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh879\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li322\ri0\lin322\rin0\fi-209\sb0\sa40\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
19. DOKUMENT UPRAWNIAJ\'a5CY DO POBYTU NA TERYTORIUM RP LUB ZWI\'a5ZANY Z TYM POBYTEM}{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
 (}{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
wype\'b3nia \line cudzoziemiec nieb\'ead\'b9cy obywatelem pa\'f1stwa cz\'b3onkowskiego Unii Europejskiej i nieb\'ead\'b9cy cz\'b3onkiem rodziny \line obywatela pa\'f1stwa cz\'b3onkowskiego Unii Europejskiej, obywatel pa\'f1stwa cz\'b3onkowskiego Unii Europejskiej,\line cz\'b3onek rodziny obywatela pa\'f1stwa cz\'b3onkowskiego Unii Europejskiej nieb\'ead\'b9cy obywatelem pa\'f1stwa \line cz\'b3onkowskiego Unii Europejskiej)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qr\sb0\sa20\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
.................................................................................................................................}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qr\sb0\sa20\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
(w\'b3asnor\'eaczny, czytelny podpis osoby wskazuj\'b9cej adres / adresy wymeldowania, a w przypadku }
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\qj\li2700\ri0\lin2700\rin0\fi0\sb0\sa20\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
Pe\'b3nomocnika \'96 seria i numer dokumentu stwierdzaj\'b9cego jego to\'bfsamo\'9c\'e6)}
\par \pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qc\sb240\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
ZG\'a3OSZENIE PRZYJ\'caTO}\cell\row\trowd\trql\trleft0\ltrrow\trrh63\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\qc\li0\ri287\lin0\rin287\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
..................................................................................................................................................................................................}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qr\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
...............................................................................}\cell\row\trowd\trql\trleft0\ltrrow\trrh63\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\qc\li113\ri0\lin113\rin0\fi0\sb0\sa40\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(NAZWA, SERIA I NUMER DOKUMENTU, OZNACZENIE ORGANU WYDAJ\'a5CEGO DOKUMENT ORAZ DATA JEGO WA\'afNO\'8cCI)}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qr\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\rtlch \ltrch\loch\fs10\loch\f4
(data i podpis urz\'eadnika przyjmuj\'b9cego zg\'b3oszenie)}\cell\row\trowd\trql\trleft0\ltrrow\trrh63\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh94\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\clvertalb\cellx13721\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\ltrpar{\afs12\rtlch \ltrch\loch\fs12
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\qr\sb40\sa0\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\intbl\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\expnd-1\expndtw-8\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\pard\plain \s0\ql\aspalpha\faauto\li0\ri0\lin0\rin0\fi0\nowidctlpar{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\langfe1045\dbch\af3\afs24\lang1025\cf0\kerning1\hich\af3\fs24\lang1045\loch\f3\li0\ri0\lin0\rin0\fi0\ltrpar{\afs2\rtlch \ltrch\loch\fs2
}
\par }