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}{\info{\title ZG\u163\'3fOSZENIE WYMELDOWANIA Z MIEJSCA POBYTU CZASOWEGO}{\doccomm ZNAKI:4310}{\author Dominik_Krus}{\creatim\yr2013\mo3\dy1\hr12\min4}{\author erdmannj}{\revtim\yr2013\mo3\dy1\hr12\min4}{\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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ZG\'a3OSZENIE WYMELDOWANIA Z MIEJSCA POBYTU CZASOWEGO}
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TRWAJ\'a5CEGO PONAD 3 MIESI\'a5CE}\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
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19. ADRES MIEJSCA POBYTU CZASOWEGO TRWAJ\'a5CEGO PONAD 3 MIESI\'a5CE}
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...............................................................................................................................................................................................}\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\sb240\sa0\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\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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...............................................................................................................................................................................................}
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(ULICA, NUMER DOMU, NUMER LOKALU)}\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\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\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\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\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
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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\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
20. DATA OPUSZCZENIA MIEJSCA POBYTU CZASOWEGO (dzie\'f1-miesi\'b9c-rok)}\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\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
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
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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\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\trrh165\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\qj\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\ltrpar{\expnd0\expndtw-2\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
NAZWA KRAJU, DO KT\'d3REGO OSOBA ZG\'a3ASZA WYJAZD NA POBYT CZASOWY TRWAJ\'a5CY PONAD 6 MIESI\'caCY}
\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\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
(}{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
wype\'b3nia osoba zg\'b3aszaj\'b9ca wyjazd za granic\'ea)}\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\qj\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\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
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\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\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\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\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\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\qc\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\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\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
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\sl276\slmult1\qc\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
STWIERDZAM WIARYGODNO\'8c\'c6 POWY\'afSZYCH DANYCH}\cell\row\trowd\trql\trleft0\ltrrow\trrh68\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\clvertalb\cellx10080\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
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\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\trrh125\trpaddft3\trpaddt0\trpaddfl3\trpaddl0\trpaddfb3\trpaddb0\trpaddfr3\trpaddr0\clbrdrr\brdrs\brdrw20\brdrcf1\clvertalc\cellx6873\clbrdrl\brdrs\brdrw20\brdrcf1\cellx7200\cellx10080\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\li485\ri0\lin485\rin0\fi0\ltrpar{\b\hich\af4\dbch\af4\afs10\ab\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\sl276\slmult1\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
(w\'b3asnor\'eaczny, czytelny podpis osoby zg\'b3aszaj\'b9cej, a w przypadku Pe\'b3nomocnika }\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\cellx10080\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\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\li360\ri0\lin360\rin0\fi0\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\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs9\ab\rtlch \ltrch\loch\fs9\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\li98\ri0\lin98\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{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
}\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\li0\ri0\lin0\rin0\fi0\sl276\slmult1\sb40\sa0\ltrpar{\i\hich\af4\dbch\af4\afs12\ai\rtlch \ltrch\loch\fs12\loch\f4
}\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) }
\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\sb120\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\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\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\sb240\sa0\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
ZG\'a3OSZENIE PRZYJ\'caTO}\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\sb240\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\qj\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
}\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\sl276\slmult1\qj\li3780\ri0\lin3780\rin0\fi0\sb0\sa200\ltrpar{\b\hich\af4\dbch\af4\afs12\ab\rtlch \ltrch\loch\fs12\loch\f4
...............................................................................}\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\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\sb240\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, kt\'f3ra pozostaje 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\sb120\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\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\li3960\ri0\lin3960\rin0\fi0\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\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\sb120\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\li0\ri0\lin0\rin0\fi0\sl276\slmult1\qj\sb0\sa200\ltrpar{\hich\af4\dbch\af4\afs10\rtlch \ltrch\loch\fs10\loch\f4
}\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\li113\ri0\lin113\rin0\fi0\sb120\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\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\qj\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\qj\sb0\sa200\ltrpar{\expnd0\expndtw-2\hich\af4\dbch\af4\afs12\rtlch \ltrch\loch\fs12\loch\f4
}\cell\row\trowd\trql\trleft0\ltrrow\trrh263\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{\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\sl276\slmult1\qc\sb240\sa0\ltrpar{\expnd0\expndtw-2\hich\af4\dbch\af4\afs12\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 \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{\rtlch \ltrch\loch
}
\par }