Příloha A.
Vzorec A.
Země: ........................ Berní okres: ....................
Politický okres: ............. Obec: ...........................
Seznam
A. peněžních vkladů,
B. členských a závodních podílů.
Jméno a povolání majitele (přednosty domácnosti): ...................
.....................................................................
Bydliště: ...........................................................
A. Vklady.
+----------+---------------+-----------+---------+-----------------------+--------+-----------------------+-----------------------+
| Druh | Jméno a sídlo | Číslo | Stránka | Jméno, příp. heslo, | Vklad | Patří vklad podateli | U koho je knížka neb |
| vkladu | ústavu | knížky, | hlavní | na které zní knížka, | v K | nebo příslušníku | poukázka uložena? |
| | | listu, | knihy | list nebo účet: | | jeho domácnosti | (Jméno a přesná |
| | | poukázky, | | | | a kterému? | adresa, číslo |
| | | účtu: | | | | | depositního listu) |
+----------+---------------+-----------+---------+-----------------------+--------+-----------------------+-----------------------+
| Vkladní | | | | | | | |
| knížky | | | | | | | |
| neb | | | | | | | |
| listy | | | | | | | |
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+----------+---------------+-----------+---------+-----------------------+--------+-----------------------+-----------------------+
| Pokladní | | | | | | | |
| poukázky | | | | | | | |
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+----------+---------------+-----------+---------+-----------------------+--------+-----------------------+-----------------------+
| Běžné | | | | | | |
| a | | | | | | |
| žirové | | | | | | |
| účty | | | | | | |
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+----------+---------------+-----------+---------+-----------------------+--------+-----------------------+
| | |
| Úhrnem ....... | |
| | |
+---------------------------------+--------+
Prohlašuji na své vědomí a svědomí, že tento seznam je
V.....................................
B. Podíly.
+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| Druh | Jméno a sídlo | Číslo knížky, | Cena | Počet kusů | Úhrnná hodnota | Patři podíl |
| podílu | společnosti, spolku, | podíl, listu | jednoho podílu | | v K | podateli nebo |
| | společenstva, družstva | a pod. | | | | příslušníku domácnosti |
| | a pod. | | | | | a kterému? |
+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| společenské | | | | | | |
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+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| spolkové | | | | | | |
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+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| společenství | | | | | | |
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+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| družstevní | | | | | | |
| (kuxy | | | | | | |
| ravovárečné, | | | | | | |
| s nemovitostí | | | | | | |
| nespojené | | | | | | |
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+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| jiné | | | | | | |
| podíly | | | | | | |
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+---------------+------------------------+---------------+----------------+-----------------+-----------------+------------------------+
| Úhrnem ... | |
+-----------------+-----------------+
| Vklady (na | |
| vedl. straně) . | |
+-----------------+-----------------+
| Úhrnem ... | |
správný a jsem ochoten to přísahou stvrditi. | | |
+-----------------+-----------------+
..........................................
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