ࡱ> oqngbjbjVV4r<r<9+8H4|D"0999Q!S!S!S!S!S!S!$"$&Dw!59|999w!"///9jQ!/9Q!//  r !q =!"0" ,'k' ' l99/99999w!w!/999"9999'999999999$ :Mestsk rad Kremnica, `tefnikovo nmestie 1/1, 967 01 Kremnica --------------------------------------------------------------------------- }iadose o poskytnutie prspevku  Jednorazov dvka vhmotnej ndzi  Prspevok vnhlej ndzi  Prspevok pri naroden dieeaea 1. Meno, priezvisko ~iadate>a/ky/:......................................................................................... Dtum narodenia :.......................................................stav:.................................................... Trval bydlisko, PS  :............................................................................................................ Prechodn bydlisko : .............................................................................................................. Poschodie :.........................................Telefn :.................................................................... slo ob ianskeho preukazu :............................................... Rodn slo :........................ slo tu:............................................................ kd banky ............................................. 2. Meno a priezvisko spolu posudzovanch osb/ rodinn vzeah : ..........................................................dtum narodenia..................................vzeah..................... ..........................................................dtum narodenia..................................vzeah..................... ..........................................................dtum narodenia..................................vzeah..................... ..........................................................dtum narodenia..................................vzeah..................... ..........................................................dtum narodenia ..................................vzeah.................... ..................................................................................................................................................... ( dolo~ie potvrdenie akoly, ~e deti nemaj neospravedlnen vyu ovacie hodiny za poslednch 12 mesiacov) 3. Po~adovan vaka prspevku: ............................................................... 4. el, na ktor sa prspevok ~iada: ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 5. Zdvodnenie ~iadosti : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ Prlohy k~iadosti: 1. Potvrdenie oprjme ~iadate>a aspolu posudzovanch osb : a/ ist mesa n prjem zo zamestnania Meno :............................................................................................................................ pe iatka, podpis Meno :............................................................................................................................ pe iatka, podpis Meno :............................................................................................................................ pe iatka, podpis b/ matersk / rodi ovsk prspevok Meno : ....................................................................vo vake........................................ pe iatka, podpis c/ evidencia na PSVaR Meno :..............................................................................................od  do:..................... Meno :.............................................................................................od do:....................... Meno :..............................................................................................od do:..................... Meno :..............................................................................................od do:..................... pe iatka, podpis d/ dvka vnezamestnanosti Meno:.................................................................................................................................. od  do: ....................................................................................vo vke:............................ Meno:.................................................................................................................................. od do: ....................................................................................vo vke:............................ Meno:................................................................................................................................... od do: ....................................................................................vo vke:............................ pe iatka, podpis e/ v~ivn na deti / slo rozsudku/ ................................................................................................................................................................................................................................................................................................................................................................................................................................................ f/ prdavky na deti: po et deti: .......................................................vo vake :................................................... pe iatka, podpis g/ dvky hmotnej ndzi : - ~iadose podan dHa:......................................................................................... - prv dvka vyplaten od mesiaca .................................................................. - vka dvky za posledn mesiac .................................................................. pe iatka, podpis h/ dchodok : predlo~ie doklad o vake dchodku( rozhodnutie, potvrdenie zpoaty ....) starobnho, invalidnho, alebo iasto ne invalidnho , sirotskho, vdovskho ... i/ samostatne zrobkovo inn osoba : ( prilo~ie fotokpiu ~ivnostenskho listu adoklad oposlednom podan daHovho priznania) j/ in dvky: Meno:..............................................................................*  H \ ` F P z("8<>6rt|LN,u!ƽ{vnvnvhxuhJP5 hJP5 hR5hRhRCJaJhR hg5hg h^5h^h^5CJaJ%jh\c5CJUaJmHnHuh^5CJ$aJ$h~h^5CJ$aJ$hyhb5CJ$aJ$hb5CJ$aJ$hbhb5CJaJhbh^5CJaJ* \ F D T f zz>J|L dhgdRdhgdRdhgd^ dhxgd^dx&dPgd^ dxgd^ dxgdb $dxa$gd^LN 2v!""""$$$&$6%P&n&p&'X((($*** dhxgd^ $dha$gd^ dhxgd^ dxgd^ dxgdJP dhxgdJPu!v!""""""""""$F%P&`&'X((***(***8*:*x*z*|*++,,y.///X000`2h2s22{33334R6666H778"9+9<9::&<L<N<ѿѳѳѳڮէ hbh^ hbhb hb5hbhfZwh^5 hghg hhh^h5hg hR5 h^5 hJP5h^hJPhJP5hJPhJP5CJaJhJP?**|*++,,-y. ///D001`22{3 444 dhxgdg dhxgdg dhxgd^ r dhxgd^ $dha$gd^ dhxgd^ dhxgd^4:6!9=9;;<R<H=>>>F@N@AAAB 3dxgd[| 3dxgd^ 3dxgd^ $dhxa$gd^ dhxgd^ dhxgdbVdhx^`VgdR $dhxa$gd^N<P<n<<b=d===(>b>L@N@Z@r@x@AAAAA BJBNBTB|BBBBBC&C(C2CDCPCbCDTzV|VVVVVW(W\W^WbWjWWXX X XXX$X:XTX\XXXXXXXXbYYY ZZZZ,[__hSghSg>*hSghbhRhR5Uhghxuh^5hRh5h[|h^ h^5MB C(CHChTxUVbWVXXYZ.[^\]^__``aa^bcd dhxgdSgdhgd^ dhxgd^ 3dxgd[|................................................... druh dvky: .....................................................................vo vake..................................... pe iatka, podpis 2. Majetkov pomery ~iadate>a a alach spolo ne posudzovanch osb / dolo~ie vpis zlistu vlastnctva/: a/ rodinn dom / no  nie/............................... b/chata /no - nie/.............................. c/ auto - gar~ /no - nie/.................................. c/ zhrada, orn pda, lesn pda, pasienky, vinohrad, in........................................................ d/ nehnute>n veci vyaaej hodnoty:........................................................................................... 4. V spolo nej domcnosti so ~iadate>om ~ij tieto osoby : ...................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... vaka njomnho :..................................................................................... Potvrdenie bytovho spolo enstva ~e: - ~iadate> nem nedoplatok - ~iadate> m nedoplatok vo vake ......................................................... VKremnici, dHa ................... pe iatka, podpis 5. Lekrske potvrdenie ak sa ~iada prspevok zdvodu zlho zdravotnho stavu: ...................................................................................................................................................... ......................................................................................................................................................... pe iatka, podpis 6. Potvrdenie, ~e s vyrovnan poh>advky vo i mestu Kremnica aorganizcim zriadench mestom. Mestsk rad potvrdzuje, ~e ~iadate> aspolu posudzovan osoby maj / nemaj vyrovnan poh>advky vo i mestu Kremnica kdtumu podania ~iadosti. VKremnici, dHa............................. Pe iatka, podpis Mestsk bytov podnik potvrdzuje, ~e ~iadate> aspolu posudzovan osoby maj / nemaj vyrovnan poh>advky kdtumu podania ~iadosti. VKremnici, dHa............................. Pe iatka, podpis `kola aakolsk zariadenie vzriaovate>skej psobnosti mesta Kremnica .................. ............................................................................................................................................... potvrdzuje, ~e ~iadate> aspolu posudzovan osoby maj / nemaj vyrovnan poh>advky kdtumu podania ~iadosti. VKremnici, dHa............................. Pe iatka, podpis Mestsk polcia potvrdzuje, ~e ~iadate> aspolu posudzovan osoby maj / nemaj vyrovnan poh>advky vo i mestu Kremnica kdtumu podania ~iadosti. VKremnici, dHa............................. Pe iatka, podpis 7. Potvrdenie Mestskej polcie v Kremnici, ~e ~iadate> aspolu posudzovan osoby neporuaili / poruaili Vaeobecne zvzn nariadenie Mesta Kremnica vobdob 12 mesiacov pred podanm ~iadosti VKremnici, dHa................................... Pe iatka, podpis 8. Shlas ~iadate>a: a) s vykonanm socilneho aetrenia vdomcnosti:................................................................. b) s doplnenm alach nevyhnutch dajov pre posdenie ~iadosti ................................... 9. Vyhlsenie ~iadate>a : Vyhlasujem, ~e vaetky daje uveden v ~iadosti s pravdiv a som si vedom() prvnych nsledkov uvedenia nepravdivch dajov. Shlasm sposkytnutm osobnch dajov ako i osobnch dajov ostatnch spolu posudzovanch osb za elom spracovania ~iadosti. Dtum :................................ Podpis ~iadate>a :........................................................... Podpis spolu posudzovanch osb: ............................................................. ............................................................. ............................................................. ............................................................. ............................................................. Vyjadrenie Mestskho radu vKremnici kpredlo~enej ~iadosti: }iadose prevzal: ........................................... dHa............................. podpis ....................... Socilne aetrenie vykonal dHa: ........................... podpis zamestnanca..................................... Kompletnose ~iadosti aslad sVZN . ........................... potvrdzuje: Dtum .................................. zamestnanec radu ......................................... 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