Çàÿâëåíèÿ îá àííóëèðîâàíèè ðàçðåøåíèÿ
íà ïðèìåíåíèå ôðàíêèðîâàëüíîé ìàøèíû
1. Âëàäåëåö ôðàíêèðîâàëüíîé
ìàøèíû: __________________________________________________________________
______________________________________________________________________________
(ïîëíîå íàèìåíîâàíèå, îðãàíèçàöèîííî-ïðàâîâàÿ ôîðìà þðèäè÷åñêîãî ëèöà â ñîîòâåòñòâèè
ñ ó÷ðåäèòåëüíûìè äîêóìåíòàìè (ôàìèëèÿ, èìÿ, îò÷åñòâî (ïðè íàëè÷èè) èíäèâèäóàëüíîãî ïðåäïðèíèìàòåëÿ)
2. Àäðåñ ìåñòîíàõîæäåíèÿ: ____________________________________________________
______________________________________________________________________________
(ìåñòî íàõîæäåíèÿ (ìåñòî æèòåëüñòâà)
þðèäè÷åñêîãî ëèöà (èíäèâèäóàëüíîãî
ïðåäïðèíèìàòåëÿ)
3. Ïî÷òîâûé àäðåñ: ____________________________________________________________
______________________________________________________________________________
(ïî÷òîâûé àäðåñ þðèäè÷åñêîãî ëèöà
(èíäèâèäóàëüíîãî ïðåäïðèíèìàòåëÿ)
4. ÈÍÍ (ÊÏÏ) _________________________________________________________________
(ÈÍÍ þðèäè÷åñêîãî ëèöà (äëÿ ôèëèàëà
þðèäè÷åñêîãî ëèöà äîïîëíèòåëüíî
óêàçûâàåòñÿ ÊÏÏ), èíäèâèäóàëüíîãî
ïðåäïðèíèìàòåëÿ)
5. ÎÃÐÍ/ÎÃÐÍÈÏ _____________________________________________________________
(ÎÃÐÍ þðèäè÷åñêîãî ëèöà, äëÿ
èíäèâèäóàëüíîãî ïðåäïðèíèìàòåëÿ
óêàçûâàåòñÿ ÎÃÐÍÈÏ)
6. Êîíòàêòíûé òåëåôîí ___________________, Ôàêñ çàÿâèòåëÿ_______________________
7. Íàèìåíîâàíèå ìîäåëè
(ñåðèè) ôðàíêèðîâàëüíîé
ìàøèíû: __________ ___________________________________________________________
8. Ìåñòî óñòàíîâêè
ôðàíêèðîâàëüíîé ìàøèíû: ______________________________________________________
______________________________________________________________________________
9. Íîìåð è äàòà âûäà÷è
àííóëèðóåìîãî ðàçðåøåíèÿ íà
ïðèìåíåíèå ôðàíêèðîâàëüíîé
ìàøèíû_____________________________________________________________________
10. Ïîäïèñü âëàäåëüöà
ôðàíêèðîâàëüíîé ìàøèíû:_____________ _________________________________________
(ñ óêàçàíèåì äîëæíîñòè, ôàìèëèè, èìåíè,
îò÷åñòâà (ïðè íàëè÷èè) ïîëíîñòüþ, ñ
ïðîñòàâëåíèåì ïå÷àòè þðèäè÷åñêîãî ëèöà
(èíäèâèäóàëüíîãî ïðåäïðèíèìàòåëÿ)