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{\b\insrsid10231821 \u1649\'3f}{\insrsid10231821 dost\'eap do przegl\'b9dania informacji w urz\'eadzie}{\b\insrsid10231821 \cell \u1649\'3f}{ \insrsid10231821 kserokopia}{\b\insrsid10231821 \cell \u1649\'3f }{\insrsid10231821 pliki komputerowe}{\b\insrsid10231821 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\b\insrsid10231821 \trowd \lastrow \ts11\trgaph70\trleft-70\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl70\trpaddr70\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4930\clshdrawnil \cellx4860\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl \brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1800\clshdrawnil 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\li360\ri0\sb100\sa100\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin360 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\b\insrsid10231821 \u1649\'3f }{ \insrsid10231821 dyskietka 3,5 }{\b\insrsid10231821 \cell \u1649\'3f }{\insrsid10231821 CD-ROM }{\b\insrsid10231821 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\insrsid10231821 \trowd \lastrow \ts11\trgaph70\trleft-70\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trpaddl70\trpaddr70\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2950\clshdrawnil \cellx2880\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2660\clshdrawnil \cellx5540\row }\pard\plain \s15\ql \li0\ri0\sb240\sa100\sbauto1\saauto1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 { \b\insrsid10231821 FORMA PRZEKAZANIA INFORMACJI: \par }\pard\plain \ql \li357\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\b\insrsid10231821 \u1649\'3f}{\insrsid10231821 Przes\'b3anie informacji poczt\'b9 elektroniczn\'b9 pod adres .................................................... \par }\pard\plain \s17\ql \fi-363\li720\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\b\insrsid10231821 \u1649\'3f}{\insrsid10231821 Przes\'b3anie informacji poczt \'b9 pod adres** ...................................................................... \line .......................................................................................................................................... \par }\pard\plain \ql \li357\ri0\sl360\slmult1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\b\insrsid10231821 \u1649\'3f}{\insrsid10231821 Odbi\'f3r osobi\'9ccie przez wnioskodawc \'ea \par }\pard\plain \s18\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\insrsid10231821 Wyra\'bfam zgod\'ea na przetwarzanie moich danych osobowych zgodnie z ustaw\'b9 o ochronie danych osobowych z dnia 29.08.1997 r. (Dz.U. .Nr 133 poz 883.z p\'f3\'9fn. zm.) \par }\pard\plain \s15\ql \fi708\li4956\ri0\sb100\sa100\sbauto1\saauto1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin4956\itap0 \fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\insrsid10231821 \par }\pard \s15\ql \fi-4956\li4956\ri0\sb100\sbauto1\saauto1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin4956\itap0 {\insrsid10231821 .....................................................\tab \tab ............................. ........................... \par }\pard \s15\ql \fi-4248\li4956\ri0\sa100\sbauto1\saauto1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin4956\itap0 {\insrsid10231821 Miejscowo\'9c\'e6, data \tab \tab \tab podpis wnioskodawcy \par }\pard \s15\ql \li0\ri0\sbauto1\saauto1\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\fs22\insrsid10231821 Uwagi: \par * prosz\'ea zakre\'9cli\'e6 w\'b3a\'9cciwe pole krzy\'bfykiem \par ** wype\'b3ni\'e6 je\'9cli adres jest inny ni\'bf podany wcze\'9cniej \par }\pard\plain \s16\ql \li0\ri0\sb120\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \b\fs24\lang1045\langfe1045\cgrid\langnp1045\langfenp1045 {\insrsid10231821 Urz\'b9d zastrzega prawo pobrania op\'b3aty od informacji udost\'ea pnionych zgodnie z art. 15 ustawy o dost\'eapie do informacji publicznej \par }}