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Ԕɨɫɵɦɲɚɦɚɥɚɪ 
ԚɅȽȱɅȿɊ 
 
Ɍɚԑɵɥɵɦɞɚɦɚɞɚɧ ԧɬɤɟɧ ɠԥɧɟ
ɧɨɬɚɪɢɚɬɬɵԕ ԕɵɡɦɟɬɩɟɧ ɚɣɧɚɥɵɫɭ
ԕԝԕɵԑɵɧɚ ԛɦɿɬɤɟɪ ɚɞɚɦɞɚɪɞɵ
ɚɬɬɟɫɬɚɬɬɚɭɞɚɧ ԧɬɤɿɡɭ ԕɚԑɢɞɚɥɚɪɵɧɚ
Ʉɨɦɢɫɫɢɹɧɵԙ ɧɨɬɚɪɢɚɬɬɵԕ ԕɵɡɦɟɬɩɟɧ 
ɚɣɧɚɥɵɫɭ ԕԝԕɵԑɵɧɚ ԛɦɿɬɤɟɪɞɿ ɚɬɬɟɫɬɚɬɬɚɭ ɬɭɪɚɥɵ ɲɟɲɿɦɿ 
_______________ ԕɚɥɚɫɵ 20_____ ɠɵɥԑɵ « ___» ___________ 
ɇɨɬɚɪɢɚɬɬɵԕ ԕɵɡɦɟɬɩɟɧ ɚɣɧɚɥɵɫɭ ԕԝԕɵԑɵɧɚ ɚɬɬɟɫɬɚɬɬɚɭ ɧԥɬɢɠɟɥɟɪɿ 
ɛɨɣɵɧɲɚ 
_____________________________________________________________ 
(Ɍ.Ⱥ.Ԥ.) 
ɬɟɫɬɿɥɟɭ ɛɨɣɵɧɲɚ _____________________ɛɚɥɥ 
ɟɦɬɢɯɚɧ ɛɢɥɟɬɿ ɛɨɣɵɧɲɚ _______________ɛɚɥɥ ɠɢɧɚɞɵ. 
Ɇɵɧɚ ԕԝɪɚɦɞɚԑɵ Ʉɨɦɢɫɫɢɹ: 
Ɍԧɪɚԑɚ 
Ɇԛɲɟɥɟɪɿ 
___________________________ ɚɬɬɟɫɬɚɬɬɚɥɫɵɧ ɞɟɩ ɲɟɲɬɿ. 
(Ɍ.Ⱥ.Ԥ.) 
Ʉɨɦɢɫɫɢɹ ɬԧɪɚԑɚɫɵ 
Ʉɨɦɢɫɫɢɹ ɯɚɬɲɵɫɵ 


181
Ɍɚԑɵɥɵɦɞɚɦɚɞɚɧ ԧɬɤɟɧ ɠԥɧɟ
ɧɨɬɚɪɢɚɬɬɵԕ ԕɵɡɦɟɬɩɟɧ ɚɣɧɚɥɵɫɭ
ԕԝԕɵԑɵɧɚ ԛɦɿɬɤɟɪ ɚɞɚɦɞɚɪɞɵ
ɚɬɬɟɫɬɚɬɬɚɭɞɚɧ ԧɬɤɿɡɭ ԕɚԑɢɞɚɥɚɪɵɧɚ
Ʉɨɦɢɫɫɢɹɧɵԙ ɧɨɬɚɪɢɚɬɬɵԕ ԕɵɡɦɟɬɩɟɧ 
ɚɣɧɚɥɵɫɭ ԕԝԕɵԑɵɧɚ ԛɦɿɬɤɟɪɞɿ ɚɬɬɟɫɬɚɬɬɚɦɚɭ ɬɭɪɚɥɵ ɲɟɲɿɦɿ 
_____________ ԕɚɥɚɫɵ 20_____ ɠɵɥԑɵ « ___» _________ 
ɇɨɬɚɪɢɚɬɬɵԕ ԕɵɡɦɟɬɩɟɧ ɚɣɧɚɥɵɫɭ ԕԝԕɵԑɵɧɚ ɚɬɬɟɫɬɚɬɬɚɭ ɧԥɬɢɠɟɥɟɪɿ 
ɛɨɣɵɧɲɚ 
___________________________________________________________ 
(Ɍ.Ⱥ.Ԥ.) 
ɬɟɫɬɿɥɟɭ ɛɨɣɵɧɲɚ _____________________ɛɚɥɥ 
ɟɦɬɢɯɚɧ ɛɢɥɟɬɿ ɛɨɣɵɧɲɚ ______________ɛɚɥɥ ɠɢɧɚɞɵ. 
Ɇɵɧɚ ԕԝɪɚɦɞɚԑɵ Ʉɨɦɢɫɫɢɹ: 
Ɍԧɪɚԑɚ 
Ɇԛɲɟɥɟɪɿ 
ɲɟɲɿɦ ɲɵԑɚɪɞɵ: 
___________________________ ɚɬɬɟɫɬɚɬɬɚɭɞɚɧ ԧɬɩɟɞɿ ɞɟɩ ɫɚɧɚɥɫɵɧ. 
(Ɍ.Ⱥ.Ԥ.) 
Ʉɨɦɢɫɫɢɹ ɬԧɪɚԑɚɫɵ 
Ʉɨɦɢɫɫɢɹ ɯɚɬɲɵɫɵ 


182
Ɂɚԙ ɛɨɣɵɧɲɚ ɦԝɪɚԑɚ ԕԝԕɵԕ ɬɭɪɚɥɵ 
ɤɭԥɥiɤ 
_______________________________________ԕɚɥɚɫɵ (ɤɟɧɬi, ɚɭɵɥɵ, ɨɛɥɵɫɵ) 
__________________________________________________________________ 
(ɤԛɧi, ɚɣɵ, ɠɵɥɵ) 
Ɇɟɧ,__________________________________________, ___________________ 
(ɦɟɦɥɟɤɟɬɬiɤ ɧɨɬɚɪɢɚɬ ɤɟԙɫɟɫiɧiԙ ɚɬɚɭɵ ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫ 
__________________________________________________________________ 
ɥɢɰɟɧɡɢɹɫɵɧɵԙ ɧԧɦiɪi ɦɟɧ ɤԛɧi) 
__________________________________________________________________ 
ɧɨɬɚɪɢɭɫɵ 
__________________________________________________________________ 
(Ɍ.Ⱥ.Ԥ) 
ԔɊ ȺɄ ______ɛɚɛɵɧɵԙ ɧɟɝiɡiɧɞɟ 20___ ɠɵɥɞɵԙ "_____"___________ԕɚɣɬɵɫ 
ɛɨɥԑɚɧ 
ɚɡɚɦɚɬ_____________________________________________________________ 
(ɦԝɪɚ ԕɚɥɞɵɪɭɲɵɧɵԙ Ɍ.Ⱥ.Ԥ.) 
ɦԛɥɤiɧɟ____________________________________________________________ 
(ɦԝɪɚɝɟɪɥɟɪɞiԙ Ɍ.Ⱥ.Ԥ., ɨɥɚɪɞɵԙ ɬԝɪԑɵɥɵԕɬɵ ɠɟɪi ɬɭԑɚɧ ɠɟɪɿ, ɨɥɚɪɞɵԙ ɦԝɪɚ 
__________________________________________________________________ 
ԕɚɥɞɵɪɭɲɵԑɚ ɬɭɵɫɬɵԕ ԕɚɬɵɧɚɫɬɚɪɵ) ԥɪԕɚɣɫɵɫɵɧɵԙ ɬɟԙ ԛɥɟɫɬɟ ɦԝɪɚɝɟɪɥɟɪ 
ɛɨɥɵɩ ɬɚɛɵɥɚɬɵɧɵɧ ɤɭԥɥɚɧɞɵɪɚɦɵɧ. Ɉɫɵ ɤɭԥɥiɤ ɛɟɪiɥɝɟɧ ɦԝɪɚɥɵԕ ɦԛɥiɤ 
ɦɵɧɚɞɚɣ ɡɚɬɬɚɪɞɚɧ ɬԝɪɚɞɵ: 
__________________________________________________________________ 
(ɤɭԥɥiɤ ɛɟɪiɥɟɬiɧ ɦԛɥiɤ ɤԧɪɫɟɬiɥɟɞi) 


183
ʋ _____ ɬiɡiɥiɦɞɟ ɬiɪɤɟɥɞi 
Ɇɟɦɥɟɤɟɬɬiɤ ɛɚɠ ԧɧɞiɪiɥɞi 
ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫԕɚ 
ɬԧɥɟɧɝɟɧ ɫɨɦɚ __________ 
ʋ____________________ 
(ɦԝɪɚɥɵԕ iɫ ɧԧɦiɪi) 
Ɇԧɪ ɇɨɬɚɪɢɭɫ________ 
(ԕɨɥɵ) 


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