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\par }\pard \qc \li6096\ri1037\sb206\sl-322\slmult0\nowidctlpar\faauto\rin1037\lin6096\itap0\pararsid13380856 \cbpat8 {\b\fs28\expnd1\expndtw9\cf1\insrsid2778631\charrsid9968666 Po}{\b\fs28\expnd1\expndtw9\cf1\insrsid8741418\charrsid9968666 wiatowy Urz\'b9
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\fs22\expnd0\expndtw1\cf1\charscalex110\insrsid8741418 (Dz. U. Nr 99, poz. 1001) sk\'b3adam wniosek o przyznanie stypendium z tytu\'b3u podj\'eacia dalszej nauki.
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\par }{\b\fs22\expnd0\expndtw-2\cf1\insrsid4019907    }{\b\fs22\expnd0\expndtw-2\cf1\insrsid8741418 gospodarcz\'b9}{\insrsid8741418 
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}\trowd \irow4\irowband4\ts11\trqr\trgaph40\trrh-288\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\pard 
\ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 \cbpat8 {\b\fs18\cf1\insrsid8741418 4.}{\insrsid8741418 \cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\insrsid8741418 \trowd \irow4\irowband4
\ts11\trqr\trgaph40\trrh-288\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\row 
}\trowd \irow5\irowband5\ts11\trqr\trgaph40\trrh-278\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\pard 
\ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 \cbpat8 {\b\fs18\cf1\insrsid8741418 5.}{\insrsid8741418 \cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\insrsid8741418 \trowd \irow5\irowband5
\ts11\trqr\trgaph40\trrh-278\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\row 
}\trowd \irow6\irowband6\ts11\trqr\trgaph40\trrh-269\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\pard 
\ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 \cbpat8 {\b\fs18\cf1\insrsid8741418 6.}{\insrsid8741418 \cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\insrsid8741418 \trowd \irow6\irowband6
\ts11\trqr\trgaph40\trrh-269\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\row 
}\trowd \irow7\irowband7\ts11\trqr\trgaph40\trrh-278\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\pard 
\ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 \cbpat8 {\b\fs18\cf1\insrsid8741418 7.}{\insrsid8741418 \cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\insrsid8741418 \trowd \irow7\irowband7
\ts11\trqr\trgaph40\trrh-278\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\row }\pard 
\ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 \cbpat8 {\b\fs18\cf1\insrsid8741418 8.}{\insrsid8741418 \cell \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\insrsid8741418 \trowd \irow8\irowband8
\ts11\trqr\trgaph40\trrh-278\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrdash\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth4666\clcbpatraw8 \cellx4626\clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrdash\brdrw10 \clbrdrb\brdrdash\brdrw10 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675\clcbpatraw8 \cellx9301\row 
}\trowd \irow9\irowband9\lastrow \ts11\trqr\trgaph40\trrh-307\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth9341\clcbpatraw8 \cellx9301\pard \ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 \cbpat8 {\b\expnd-1\expndtw-6\cf1\insrsid8741418 Razem doch\'f3d:}{\insrsid8741418 \cell }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\insrsid8741418 \trowd \irow9\irowband9\lastrow \ts11\trqr\trgaph40\trrh-307\trleft-40\trftsWidth1\trpaddl40\trpaddr40\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrdash\brdrw10 
\clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth9341\clcbpatraw8 \cellx9301\row }\pard \ql \li7439\ri0\nowidctlpar\faauto\rin0\lin7439\itap0\pararsid4152469 \cbpat8 {
\fs22\expnd0\expndtw3\cf1\insrsid4152469 
\par 
\par 
\par }\pard \ql \fi-493\li7439\ri0\nowidctlpar\faauto\rin0\lin7439\itap0\pararsid4152469 \cbpat8 {\fs22\expnd0\expndtw3\cf1\insrsid4152469 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..
\par }\pard \ql \li7439\ri0\nowidctlpar\faauto\rin0\lin7439\itap0\pararsid4152469 \cbpat8 {\fs22\expnd0\expndtw3\cf1\insrsid8741418 (podpis wnioskodawcy)}{\insrsid8741418 
\par }\pard \ql \li0\ri0\sb470\nowidctlpar\faauto\rin0\lin0\itap0 \cbpat8 {\fs16\ul\expnd0\expndtw-2\cf1\insrsid8741418 *) niepotrzebne skre\'9cli\'e6}{\insrsid8741418 
\par \sect }\sectd \marglsxn788\margrsxn581\margtsxn1440\margbsxn720\linex0\headery708\footery708\colsx60\sectdefaultcl\sftnbj \pard\plain \ql \li67\ri0\nowidctlpar\faauto\rin0\lin67\itap0 \cbpat8 \fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {
\b\fs24\ul\expnd-1\expndtw-9\cf1\insrsid6370728 Cz\'ea}{\b\fs24\ul\expnd-1\expndtw-9\cf1\insrsid8741418\charrsid4019907 \'9c\'e6 III}{\b\insrsid8741418\charrsid4019907 
\par }\pard \ql \li1066\ri0\sb226\nowidctlpar\faauto\rin0\lin1066\itap0 \cbpat8 {\fs24\expnd0\expndtw2\cf1\insrsid8741418 O\'9cwiadczam, \'bfe z powy\'bfszego dochodu utrzymuj\'b9 si\'ea nast\'eapuj\'b9ce osoby:}{\insrsid8741418 
\par }\pard \ql \li1080\ri0\sb125\sl-317\slmult0\nowidctlpar\tldot\tx5213\faauto\rin0\lin1080\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 1}{\fs22\cf1\insrsid14572438 .  \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..}{\insrsid8741418 

\par }\pard \ql \li1051\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5208\faauto\rin0\lin1051\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 2}{\fs22\cf1\insrsid14572438 .  \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..}{\insrsid8741418 
\par }\pard \ql \li1051\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5203\faauto\rin0\lin1051\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 3}{\fs22\cf1\insrsid14572438 .   \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.}{\insrsid8741418 
\par }\pard \ql \li1046\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5198\faauto\rin0\lin1046\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 4}{\fs22\cf1\insrsid14572438 .   \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.}{\insrsid8741418 
\par }\pard \ql \li1051\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5203\faauto\rin0\lin1051\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 5}{\fs22\cf1\insrsid14572438 .   \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.}{\insrsid8741418 
\par }\pard \ql \li1042\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5198\faauto\rin0\lin1042\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 6}{\fs22\cf1\insrsid14572438 .   \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.}{\insrsid8741418 
\par }\pard \ql \li1042\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5194\faauto\rin0\lin1042\itap0 \cbpat8 {\fs22\expnd-2\expndtw-10\cf1\insrsid8741418 7.    }{\fs22\cf1\insrsid14572438 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.}{
\insrsid8741418 
\par }\pard \ql \li1037\ri0\sl-317\slmult0\nowidctlpar\tldot\tx5189\faauto\rin0\lin1037\itap0 \cbpat8 {\fs22\cf1\insrsid8741418 8}{\fs22\cf1\insrsid14572438 .   \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.}{\insrsid8741418 
\par }\pard \ql \fi341\li1037\ri0\sb403\nowidctlpar\faauto\rin0\lin1037\itap0\pararsid8329426 \cbpat8 {\expnd0\expndtw3\cf1\insrsid8741418\charrsid13566333 O\'9cwiadczam, \'bfe zosta\'b3em(am) pouczony(a) o odpowiedzialno\'9cci karnej przewidzianej w art. 233 
}{\cf1\insrsid8741418\charrsid13566333 Kodeksu Karnego za z\'b3o\'bfenie danych niezgodnych z prawd\'b9.}{\insrsid8741418\charrsid13566333 
\par }\pard \qj \fi230\li1027\ri274\nowidctlpar\faauto\rin274\lin1027\itap0\pararsid8329426 \cbpat8 {\expnd0\expndtw1\cf1\insrsid8741418\charrsid13566333 Art. 233 K.K. \'a7 l:,,Kto sk\'b3adaj\'b9c zeznania maj\'b9ce s\'b3u\'bfy\'e6 za dow\'f3d w post\'ea
powaniu s\'b9dowym, lub }{\expnd1\expndtw5\cf1\insrsid8741418\charrsid13566333 innym post\'eapowaniu prowadzonym na podstawie ustawy, zeznaje nieprawd\'ea lub zataja prawd\'ea, }{\expnd0\expndtw-1\cf1\insrsid8741418\charrsid13566333 
podlega karze pozbawienia wolno\'9cci}{\fs22\expnd0\expndtw-1\cf1\insrsid15955020  do lat 3\'94}{\fs22\expnd0\expndtw-1\cf1\insrsid8741418 .}{\insrsid8741418 
\par }\pard \ql \li1015\ri2189\sb130\nowidctlpar\faauto\rin2189\lin1015\itap0\pararsid12007736 \cbpat8 {\fs22\expnd0\expndtw-1\cf1\insrsid8741418 Wyra\'bfam zgod\'ea na przetwarzanie danych znajduj\'b9cych si\'ea w niniejszym wniosku. }{
\fs22\cf1\insrsid8741418 Ja ni\'bfej podpisany o\'9cwiadczam, \'bfe dane zawarte we wniosku s\'b9 zgodne z prawd\'b9.
\par }{\fs22\cf1\insrsid13135227 
\par 
\par 
\par }\pard \ql \li1015\ri50\sb130\nowidctlpar\faauto\rin50\lin1015\itap0\pararsid13135227 \cbpat8 {\insrsid13135227 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.\tab \tab \tab \tab \tab \'85\'85\'85\'85\'85.....................................

\par }\pard \ql \li1480\ri0\sb60\nowidctlpar\tx7522\faauto\rin0\lin1480\itap0\pararsid8935454 \cbpat8 {\fs24\expnd0\expndtw-4\cf1\insrsid8741418 (miejscowo\'9c\'e6 i data)}{\fs24\cf1\insrsid8741418 \tab }{\fs24\expnd-1\expndtw-5\cf1\insrsid8741418 
(podpis wnioskodawcy)}{\insrsid8741418 
\par }\pard \ql \li0\ri0\sb408\nowidctlpar\faauto\rin0\lin0\itap0 \cbpat8 {\b\fs24\ul\expnd1\expndtw9\cf1\insrsid8741418 Cz\'ea\'9c\'e6 }{\b\fs24\ul\expnd1\expndtw9\cf1\insrsid8741418\charrsid1513372 IV}{\insrsid8741418 
\par }\pard \ql \li2770\ri0\sb120\nowidctlpar\faauto\rin0\lin2770\itap0 \cbpat8 {\b\fs26\expnd2\expndtw14\cf1\insrsid8741418 Wype\'b3nia Powiatowy Urz\'b9d Pracy w }{\b\fs26\expnd2\expndtw14\cf1\insrsid13380856 Pi\'f1czowie}{\insrsid8741418 
\par {\pntext\pard\plain\fs26\expnd0\expndtw1\cf1\insrsid8741418 \hich\af0\dbch\af0\loch\f0 1.\tab}}\pard \ql \li624\ri0\sb758\sl-542\slmult0\nowidctlpar\tx989\tlul\tx10363{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0\pndec\pnstart1\pnindent365 {\pntxta .}}
\faauto\ls2\rin0\lin624\itap0\pararsid1513372 \cbpat8 {\fs26\expnd0\expndtw1\cf1\insrsid8741418 Razem dochody}{\fs26\cf1\insrsid8741418 \tab }{\fs26\expnd-1\expndtw-7\cf1\insrsid8741418 z\'b3}{\fs26\expnd-4\expndtw-21\cf1\insrsid8741418 
\par {\pntext\pard\plain\fs26\expnd0\expndtw1\cf1\insrsid8741418 \hich\af0\dbch\af0\loch\f0 2.\tab}}\pard \ql \li624\ri0\sl-542\slmult0\nowidctlpar\tx989\tlul\tx10531{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0\pndec\pnstart1\pnindent365 {\pntxta .}}
\faauto\ls2\rin0\lin624\itap0\pararsid1513372 \cbpat8 {\fs26\expnd0\expndtw1\cf1\insrsid8741418 Liczba cz\'b3onk\'f3w rodziny pozostaj\'b9cych we wsp\'f3lnym gospodarstwie domowym}{\fs26\cf1\insrsid8741418 \tab }{\fs26\expnd0\expndtw-1\cf1\insrsid8741418 

\par {\pntext\pard\plain\fs26\expnd2\expndtw13\cf1\insrsid8741418 \hich\af0\dbch\af0\loch\f0 3.\tab}}\pard \ql \li624\ri0\sl-542\slmult0\nowidctlpar\tx989\tlul\tx9691\tx10358{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0\pndec\pnstart1\pnindent365 {\pntxta .}}
\faauto\ls2\rin0\lin624\itap0\pararsid1513372 \cbpat8 {\fs26\expnd2\expndtw13\cf1\insrsid8741418 Przeci\'eatny miesi\'eaczny doch\'f3d na jedn\'b9 osob\'ea w rodzinie wynosi:}{\fs26\ul\expnd2\expndtw13\cf1\insrsid11626328                       }{
\fs26\expnd0\expndtw-4\cf1\insrsid8741418 z\'b3}{\fs26\expnd0\expndtw-1\cf1\insrsid8741418 
\par {\pntext\pard\plain\fs26\expnd3\expndtw16\cf1\insrsid8741418 \hich\af0\dbch\af0\loch\f0 4.\tab}}\pard \ql \li624\ri0\sb216\nowidctlpar\tx989\tlul\tx10339{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0\pndec\pnstart1\pnindent365 {\pntxta .}}
\faauto\ls2\rin0\lin624\itap0\pararsid1513372 \cbpat8 {\fs26\expnd3\expndtw16\cf1\insrsid8741418 Stypendium}{\fs26\cf1\insrsid8741418 \tab }{\fs26\expnd0\expndtw-3\cf1\insrsid8741418 z\'b3}{\fs26\expnd0\expndtw-2\cf1\insrsid8741418 
\par }\pard \ql \li0\ri0\nowidctlpar\tx6734\faauto\rin0\lin0\itap0\pararsid13722086 \cbpat8 {\fs24\expnd0\expndtw-4\cf1\insrsid13722086 
\par 
\par 
\par 
\par 
\par }\pard \ql \li0\ri0\nowidctlpar\tx993\faauto\rin0\lin0\itap0\pararsid13722086 \cbpat8 {\fs24\expnd0\expndtw-4\cf1\insrsid13722086 
\par \tab }{\fs24\ul\expnd0\expndtw-4\cf1\insrsid13722086\charrsid13722086 
\par }\pard \ql \li1429\ri0\sb120\nowidctlpar\tx6734\faauto\rin0\lin1429\itap0\pararsid13722086 \cbpat8 {\lang1024\langfe1024\noproof\insrsid156637 
{\shp{\*\shpinst\shpleft6193\shptop15\shpright9793\shpbottom15\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz1\shplid1026{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8193\dpline\dpptx0\dppty0\dpptx3600\dppty0
\dpx6193\dpy15\dpxsize3600\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft1033\shptop15\shpright3793\shpbottom15\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz0\shplid1027
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8192\dpline\dpptx0\dppty0\dpptx2760\dppty0\dpx1033\dpy15\dpxsize2760\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\fs24\expnd0\expndtw-4\cf1\insrsid8741418 (miejscowo\'9c\'e6 i data)}{\fs24\cf1\insrsid8741418 \tab (podpis pracownika urz\'eadu)
\par }\pard \ql \li0\ri0\sb120\nowidctlpar\tx6734\faauto\rin0\lin0\itap0\pararsid15871710 \cbpat8 {\fs24\cf1\insrsid15871710 
\par }{\fs16\ul\cf1\insrsid15871710\charrsid6370728 *) niepotrzebne skre\'9cli\'e6}{\fs16\ul\insrsid15871710\charrsid6370728 
\par }}