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_______________________________ԕɚɥɚɫɵ (ɚɭɵɥɵ, ɤɟɧɬi, ԧɥɤɟɫi, ɨɛɥɵɫɵ) _______________________________________ԕɚɥɚɫɵ (ɤɟɧɬi, ɚɭɵɥɵ, ɨɛɥɵɫɵ) __________________________________________________________________ (ɤԛɧi, ɚɣɵ, ɠɵɥɵ) Ɇɟɧ,___________________________________________,___________________ (ɦɟɦɥɟɤɟɬɬiɤ ɧɨɬɚɪɢɚɬ ɤɟԙɫɟɫiɧiԙ ɚɬɚɭɵ ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫ __________________________________________________________________ ɥɢɰɟɧɡɢɹɫɵɧɵԙ ɧԧɦiɪi ɦɟɧ ɤԛɧi) __________________________________________________________________ ɧɨɬɚɪɢɭɫɵ __________________________________________________________________ (Ɍ.Ⱥ.Ԥ.) ______ɠɵɥɞɵԙ "_____"_____ ________________________________________ (ԧɫɢɟɬɬi ɤɭԥɥɚɧɞɵɪԑɚɧ ɧɨɬɚɪɢɚɬɬɵԕ ɨɪɝɚɧɧɵԙ ɧɟɝiɡiɧɞɟ ɚɬɚɭɵ) ________________ɤɭԥɥɚɧɞɵɪɵɥԑɚɧ ɠԥɧɟ ʋ_ ɬiɡiɥiɦɞɟ ɬiɪɤɟɥɝɟɧ ԧɫɢɟɬɬiԙ ԕɚɧɞɚɣ ɠɚԑɞɚɣɞɚ ɛɨɥɦɚɫɵɧ ɠԥɧɟ ԕɚɣ ɠɟɪɞɟ ɛɨɥɦɚɫɵɧ 20___ɠɵɥɞɵԙ "__"___ ԕɚɣɬɵɫ ɛɨɥԑɚɧ ɚɡ. ________________________________ ԧɫɢɟɬiɧɞɟ ɚɬɚɥԑɚɧ ɦԛɥɤiɧɟ ____________________________________________________________ (ɦԝɪɚɝɟɪɥɟɪɞiԙ ɬɟɤɬɟɪi, ɚɬɬɚɪɵ, ԥɤɟɥɟɪiɧiԙ ɚɬɬɚɪɵ ɠԥɧɟ ɤɭԥɥɚɧɞɵɪɚɦɵɧ. ________________________ ɦԝɪɚɝɟɪɥɟɪ ɛɨɥɵɩ ɬɚɛɵɥɚɬɵɧɵɧ ɨɥɚɪɞɵԙ ɬԝɪԑɵɥɵԕɬɵ ɠɟɪi) ʋ __________________ (ɦԝɪɚɥɵԕ iɫ ɧԧɦiɪi) ʋ _______ɬiɡiɥiɦɞɟ ɬiɪɤɟɥɞi Ɇɟɦɥɟɤɟɬɬiɤ ɛɚɠ ԧɧɞiɪiɥɞi ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫԕɚ ɬԧɥɟɧɝɟɧ ɫɨɦɚ ________ ɦԧɪ ɇɨɬɚɪɢɭɫ __________________ (ԕɨɥɵ) 184 Ɇɟɧɲiɤ ԕԝԕɵԑɵ 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 «ɇɟɤɟ ɠԥɧɟ ɨɬɛɚɫɵ (ɫɭɩɪɭɠɟɫɬɜɟ) ɬɭɪɚɥɵ» Ʉɨɞɟɤɫiɧiԙ ______ ɛɚɛɵɧɵԙ ɧɟɝiɡiɧɞɟ ɠԥɧɟ ɚɡ.ɚɡ._____________________________________________________________ (ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ Ɍ.Ⱥ.Ԥ ɠԥɧɟ ɨɥɚɪɞɵԙ ɬԝɪԑɵɥɵԕɬɵ ɠɟɪi) __________________________________________________________________ ɚɪɵɡɞɚɪɵɧɚ ɫԥɣɤɟɫ ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ ɧɟɤɟɞɟ ɬԝɪԑɚɧ ɤɟɡiɧɞɟ ɠɢɧɚԑɚɧ ɨɪɬɚԕ ɦԛɥɤiɧɞɟ ɦɟɧɲiɤ ԕԝԕɵԑɵ _______________________________________ (ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ ԕɚɣɫɵɫɵɧɚ ɨɪɬɚԕ ɦԛɥiɤɬɟɧ ԛɥɟɫ ɠɚɬɚɬɵɧɵ ɤԧɪɫɟɬiɥɟɞi) ԕɚɧɞɚɣ __________________________________ ɠɚɬɚɬɵɧɵɧ ɤɭԥɥɚɧɞɵɪɚɦɵɧ. Ⱥɬɚɥԑɚɧ ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ ɚɬɚɥԑɚɧ ԛɥɟɫɬɟ ɦɟɧɲiɤ ԕԝԕɵԑɵ ɤɭԥɥɚɧɞɵɪɵɥԑɚɧ ɨɪɬɚԕ ɛiɪɥɟɫɤɟɧ ɦԛɥɤi ɦɵɧɚɞɚɣ ɡɚɬɬɚɪɞɚɧ ɬԝɪɚɞɵ:______ __________________________________________________________________ (ɦɟɧɲiɤ ԕԝԕɵԑɵ ɬɭɪɚɥɵ ɤɭԥɥiɤ ɛɟɪiɥɝɟɧ ɦԛɥiɤ ɤԧɪɫɟɬiɥɟɞi, ɨɥ ɤiɦɧiԙ __________________________________________________________________ ɚɬɵɧɞɚ ɛɨɥɞɵ ɧɟɦɟɫɟ ɛԝɪɵɧ ɤiɦɧiԙ ɚɬɵɧɚ ɬiɪɤɟɥɞi) ʋ _______ɬiɡiɥiɦɞɟ ɬiɪɤɟɥɞi Ɇɟɦɥɟɤɟɬɬiɤ ɛɚɠ ԧɧɞiɪiɥɞi ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫԕɚ ɬԧɥɟɧɝɟɧ ɫɨɦɚ ________ ɦԧɪ ɇɨɬɚɪɢɭɫ ___________________ |