Vzorec č. 2
Země: ...................................
Finanční okres: .........................
Oddělení finanční stráže: ...............
Odběrní kniha č. .....
berních známek pro zvláštní dávku z vína v lahvích.
Jméno majitelovo: ..........................................
Druh živnosti: .............................................
Sídlo podniku: .............................................
Tato odběrní kniha byla vydána dne .................. 19....
úřadem: ...........................
Cena prodejní: ............................................
+-----------------------------------------------------------------------+-------------------+
| Odebráno známek berních na zvláštní dávku z vína v lahvích | |
| | Podpis úředníka, |
| | známky berní |
+---------+----------------------------------------+----------+---------+ vydávajícího |
| Dne, | Kusů po korunách | V úhrnné | Pod | |
| měsíce, | | ceně | článkem | |
| roku +---+---+---+---+---+---+---+---+---+----+ K | | |
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