| ID | 11193 |
|---|---|
| Data | 2022-01-03 |
| Symbol | 2022/01/03/11193 |
| Instytucja | Urząd Gminy Lyski |
| Nazwa | Deklaracja o wysokości opłaty za gospodarowanie odpadami komunalnymi |
| Czy Aktualny | 1 |
| Ustawa z dnia 13 września 1996 r. o utrzymaniu czystości i porządku w gminach |
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<p align="center" class="Default"> <span style="font-size: small; font-family: verdana, geneva;"><strong>DEKLARACJA O WYSOKOŚCI OPŁATY ZA GOSPODAROWANIE ODPADAMI
KOMUNALNYMI<br/></strong></span></p>
<table border="0" cellpadding="0" cellspacing="0" style="border: 0px solid #000000; width: 100%;">
<tbody>
<tr>
<td align="left" colspan="2" style="width: 20%;" valign="middle"> </td>
</tr>
<tr>
<td align="left" style="background-color: #e2e2e2; width: 20%; border-top-style: solid; border-right-style: solid; border-left: 1px solid #000000; border-top-width: 1px; border-right-width: 1px; border-top-color: #000000; border-right-color: #000000;" valign="middle">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Podstawa prawna:</strong>
</span>
</td>
<td align="left" style="background-color: #e2e2e2; width: 80%; border-top-style: solid; border-right-style: solid; border-top-width: 1px; border-right-width: 1px; border-left-width: 0px; border-top-color: #000000; border-right-color: #000000; text-align: justify;" valign="middle">
<span style="font-size: x-small; font-family: verdana, geneva;">Ustawa z dnia 13 września 1996 r. o utrzymaniu czystości i
porządku w gminach (Dz. U. z 2021 r. poz. 888 z późn.
zm.)</span>
</td>
</tr>
<tr>
<td align="left" style="background-color: #e2e2e2; width: 20%; border-top-style: solid; border-right-style: solid; border-left: 1px solid #000000; border-top-width: 1px; border-right-width: 1px; border-top-color: #000000; border-right-color: #000000;" valign="middle">
<span style="font-family: verdana, geneva; font-size: x-small;">
<strong>Składający:</strong>
</span>
</td>
<td align="left" style="background-color: #e2e2e2; width: 80%; border-top-style: solid; border-right-style: solid; border-top-width: 1px; border-right-width: 1px; border-left-width: 0px; border-top-color: #000000; border-right-color: #000000; text-align: justify;" valign="middle">
<span style="font-size: x-small; font-family: verdana, geneva;">Formularz przeznaczony dla właścicieli nieruchomości w
rozumieniu art. 2 ust. 1 pkt 4 ustawy z dnia 13 września
1996 r. o utrzymaniu czystości i porządku w gminach (Dz. U.
z 2021 r. poz. 888 z późn. zm.)</span>
</td>
</tr>
<tr>
<td align="left" style="background-color: #e2e2e2; width: 20%; border-top-style: solid; border-right-style: solid; border-left: 1px solid #000000; border-top-width: 1px; border-right-width: 1px; border-top-color: #000000; border-right-color: #000000;" valign="middle">
<span style="font-family: verdana, geneva; font-size: x-small;">
<strong>Miejsce składania:</strong>
</span>
</td>
<td align="left" style="background-color: #e2e2e2; width: 80%; border-top-style: solid; border-right-style: solid; border-top-width: 1px; border-right-width: 1px; border-left-width: 0px; border-top-color: #000000; border-right-color: #000000; text-align: justify;" valign="middle">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Urząd Gminy Lyski</span>
</strong>
</td>
</tr>
<tr>
<td align="left" style="background-color: #e2e2e2; width: 20%; border-style: solid; border-width: 1px; border-color: #000000;" valign="middle">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Organ właściwy do którego należy złożyć
deklarację:</span>
</strong>
</td>
<td align="left" style="background-color: #e2e2e2; width: 80%; border-style: solid; border-width: 1px 1px 1px 0px; border-color: #000000; text-align: justify;" valign="middle">
<span style="font-size: x-small; font-family: verdana, geneva;"> <strong>Wójt Gminy
Lyski</strong><strong><br/></strong></span>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="background-color: #e2e2e2; text-align: left; border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<strong>
<span style="font-size: small; font-family: verdana, geneva;">A. OBOWIĄZEK ZŁOŻENIA DEKLARACJI<br/></span>
</strong>
</td>
</tr>
<tr>
<td style="text-align: left; border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Okoliczności powodujące obowiązek złożenia
deklaracji:</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0) = normalize-space(' 1 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Pierwsza
deklaracja
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0) = normalize-space(' 2 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Nowa
deklaracja
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0) = normalize-space(' 3 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Korekta
deklaracji
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0) = normalize-space(' 4 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Wygaśnięcie
obowiązku
</span></label></span></xsl:if></span><br/></span>
</p>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID8">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0 = '1'">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Data powstania obowiązku: <strong><xsl:if test="true()"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID116"/></xsl:if></strong></span>
</p>
</xsl:if>
</xsl:for-each>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID113">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0 = '2'">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Data zmiany ilości mieszkańców zamieszkujących
nieruchomość: <strong><xsl:if test="true()"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID117"/></xsl:if></strong></span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Przyczyna zaistnienia zmiany:</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span>
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID12"/>
</span>
</xsl:if>
</span>
</span>
</p>
</xsl:if>
</xsl:for-each>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID115">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0 = '3'">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Okres, którego dotyczy korekta: <strong><xsl:if test="true()"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID118"/></xsl:if></strong> do dnia <strong><xsl:if test="true()"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID119"/></xsl:if></strong></span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Przyczyna korekty deklaracji:</span>
</p>
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span>
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID16"/>
</span>
</xsl:if>
</span>
</span>
</p>
</xsl:if>
</xsl:for-each>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID114">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID0 = '4'">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Data wygaśnięcia obowiązku: <strong><xsl:if test="true()"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID120"/></xsl:if></strong></span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Przyczyna wygaśnięcia obowiązku
podatkowego:</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> </strong>
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span>
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID24"/>
</span>
</xsl:if>
</span>
</span>
</p>
</xsl:if>
</xsl:for-each>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="background-color: #e2e2e2; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>B. DANE WŁAŚCICIELA NIERUCHOMOŚĆI<br/></strong>
</span>
</td>
</tr>
<tr>
<td style="background-color: #ffffff; border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Składający:</strong>
<br/>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span>
<xsl:choose>
<xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4) = normalize-space(' 1 ')">
<span>[<b>X</b>]</span>
</xsl:when>
<xsl:otherwise>
<span>[ ]</span>
</xsl:otherwise>
</xsl:choose>
<label>
<span>Osoba fizyczna </span>
</label>
</span>
<br/>
<span>
<xsl:choose>
<xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4) = normalize-space(' 2 ')">
<span>[<b>X</b>]</span>
</xsl:when>
<xsl:otherwise>
<span>[ ]</span>
</xsl:otherwise>
</xsl:choose>
<label>
<span>Osoba prawna </span>
</label>
</span>
<br/>
<span>
<xsl:choose>
<xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4) = normalize-space(' 3 ')">
<span>[<b>X</b>]</span>
</xsl:when>
<xsl:otherwise>
<span>[ ]</span>
</xsl:otherwise>
</xsl:choose>
<label>
<span>Jednostka organizacyjna nie posiadająca
osobowości prawnej </span>
</label>
</span>
</xsl:if>
</span>
</span>
</p>
</td>
</tr>
<tr>
<td style="background-color: #ffffff; border-right: 1px solid #000000; border-left: 1px solid #000000; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Tytuł prawny do nieruchomości:</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID3) = normalize-space(' 1 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Właściciel
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID3) = normalize-space(' 2 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Współwłaściciel
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID3) = normalize-space(' 3 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Użytkownik
wieczysty
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID3) = normalize-space(' 4 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Jednostka
organizacyjna lub osoba posiadająca nieruchomość w
zarządzie lub użytkowaniu
</span></label></span><br/><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID3) = normalize-space(' 5 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Inne
podmioty władające nieruchomością (najemca i
dzierżawca, posiadacz samoistny, posiadacz
zależny)
</span></label></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="border-top-style: solid; border-right-style: solid; border-left: 1px solid #000000; border-top-width: 1px; border-right-width: 1px; border-top-color: #000000; border-right-color: #000000;">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID5">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4 = '1'">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="width: 50%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Nazwisko</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID7"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Imię</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID15"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 50%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Imię ojca</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID1"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Imię matki</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID2"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td colspan="2" style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">PESEL</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID17"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td colspan="2" style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Osoba upoważniona do reprezentowania</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID13"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</xsl:if>
</xsl:for-each>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID6">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4 != '1'">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="2" style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Pełna nazwa</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: trebuchet ms, geneva;"> <span style="font-family: verdana, geneva;"><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID26"/></span></xsl:if></span></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 50%; border-right-style: solid; border-bottom: 1px solid #000000; border-right-width: 1px; border-right-color: #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">REGON</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID30"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">NIP</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID31"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td colspan="2" style="width: 50%; border-bottom: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Osoba upoważniona do
reprezentowania</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID14"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</xsl:if>
</xsl:for-each>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td style="background-color: #ffffff; border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID23">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4 = '1'">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="3" style="background-color: #e2e2e2; width: 33%; border-bottom: 1px solid #000000;">
<strong>
<span style="font-size: small; font-family: verdana, geneva;">ADRES ZAMIESZKANIA SKŁADAJĄCEGO
DEKLARACJĘ<br/></span>
</strong>
</td>
</tr>
<tr>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Kraj</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID42"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Województwo</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID43"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Powiat</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID44"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Gmina</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID45"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Miejscowość</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID46"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Kod pocztowy</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID47"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Ulica</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID48"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Numer domu</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID49"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Numer lokalu</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID50"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; border-right: 1px solid #000000; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Poczta</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID18"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-right: 1px solid #000000; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Telefon</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID19"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Adres e-mail</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID20"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</xsl:if>
</xsl:for-each>
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID22">
<xsl:if test="//wnio:TrescDokumentu/wnio:Wartosc/wnio:ID4 != '1'">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="3" style="background-color: #e2e2e2; width: 33%; border-bottom: 1px solid #000000;">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>ADRES SIEDZIBY SKŁADAJĄCEGO
DEKLARACJĘ</strong>
</span>
</td>
</tr>
<tr>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Kraj</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID51"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Województwo</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID52"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Powiat</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID53"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Gmina</strong>
</span>
</p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID54"/></span></xsl:if></span></span>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Miejscowość</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID55"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
<td style="width: 33%; border-bottom: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Kod pocztowy</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID56"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; border-right: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Ulica</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID57"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
<td style="width: 33%; border-right: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Numer domu</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID58"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
<td style="width: 33%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Numer lokalu</strong>
</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID59"/></span></xsl:if></span><br/></strong>
</span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; border-right: 1px solid #000000; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Poczta</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID21"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-right: 1px solid #000000; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Telefon</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID25"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33%; border-top: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Adres e-mail</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID27"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</xsl:if>
</xsl:for-each>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td style="background-color: #e2e2e2; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;">
<strong>
<span style="font-size: small; font-family: verdana, geneva;">C. ADRES NIERUCHOMOŚCI, NA KTÓREJ POWSTAJĄ ODPADY
KOMUNALNE<br/></span>
</strong>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="width: 33.33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Gmina</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID29"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33.33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Ulica</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID36"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33.33%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Numer domu</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID38"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 33.33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Numer lokalu</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID32"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33.33%; border-bottom: 1px solid #000000; border-right: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Miejscowość</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID37"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 33.33%; border-bottom: 1px solid #000000;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Kod pocztowy</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID39"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td colspan="3" style="width: 33.33%;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Poczta</span>
</strong>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID28"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="font-family: verdana, geneva; font-size: small; background-color: #e2e2e2; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>D. OŚWIADCZENIE SKŁADAJĄCEGO
DEKLARACJĘ<br/></strong>
</span>
</td>
</tr>
</tbody>
</table>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="border-style: solid; border-width: 0px 1px 1px; border-color: #000000; width: 33.33%;">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="2" style="width: 33.33%;"> </td>
<td style="width: 33.33%;"> </td>
</tr>
<tr>
<td colspan="2" style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;">1) Oświadczam, że na terenie nieruchomości
wskazanej w części C niniejszej deklaracji
zamieszkuje</span>
</td>
<td style="width: 33.33%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID40"/>
</span>
</xsl:if>
</span>
</strong>
</span>
</p>
</td>
</tr>
<tr>
<td colspan="2" style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
</tr>
<tr>
<td colspan="3" style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Wysokość opłaty miesięcznej za
gospodarowanie odpadami komunalnymi
wynosi:</strong>
</span>
</td>
</tr>
<tr>
<td colspan="3" style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
</tr>
<tr>
<td style="width: 33.33%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID41"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
<td style="width: 33.33%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID60"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
<td style="width: 33.33%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID61"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
</tr>
<tr>
<td style="width: 33.33%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(liczba mieszkańców)</span>
</td>
<td style="width: 33.33%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(stawka opłaty)</span>
</td>
<td style="width: 33.33%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(iloczyn liczby mieszkańców i stawki
opłaty)</span>
</td>
</tr>
<tr>
<td style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 33.33%;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td style="border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">2) Oświadczam, że na terenie nieruchomości wskazanej w
części C niniejszej deklaracji znajduje się przydomowy
kompostownik i kompostowane są w nim bioodpady
stanowiące odpady komunalne:</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID62) = normalize-space(' 1 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Tak
</span></label></span><span><xsl:choose><xsl:when test="normalize-space(wnio:TrescDokumentu/wnio:Wartosc/wnio:ID62) = normalize-space(' 2 ')"><span>[<b>X</b>]</span></xsl:when><xsl:otherwise><span>[
]</span></xsl:otherwise></xsl:choose><label><span>Nie
</span></label></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="border-style: solid; border-width: 0px 1px 1px; border-color: #000000;">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="3" style="width: 33%;"> </td>
</tr>
<tr>
<td colspan="3" style="width: 33%;">
<span style="font-size: x-small; font-family: verdana, geneva;">3) Wysokość opłaty za gospodarowanie odpadami
komunalnymi uwzględniająca wysokość zwolnienia z
obliczonej opłaty, o której mowa w art. 6k ust. 4a
ustawy o utrzymaniu czystości i porządku w
gminach, uchwalonej odrębną uchwałą Rady Gminy
Lyski:</span>
</td>
</tr>
<tr>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
</tr>
<tr>
<td style="width: 33%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID63"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
<td style="width: 33%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID64"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
<td style="width: 33%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID65"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
</tr>
<tr>
<td style="width: 33%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(wysokość miesięcznej opłaty)</span>
</td>
<td style="width: 33%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(wysokość zwolnienia)</span>
</td>
<td style="width: 33%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(należna opłata)</span>
</td>
</tr>
<tr>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
</tr>
<tr>
<td colspan="2" style="width: 33%;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Wysokość opłaty miesięcznej za gospodarowanie
odpadami komunalnymi wynosi:</span>
</strong>
</td>
<td style="width: 33%;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID67"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
</tr>
<tr>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
</tr>
<tr>
<td colspan="3" style="width: 33%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Słownie: <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID66"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
<td style="width: 33%;"> </td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<div>
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td align="left" colspan="3" style="background-color: #e2e2e2; width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>E. OŚWIADCZENIE SKŁADAJĄCEGO DEKLARACJĘ</strong>
</span>
<br/>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="8" style="width: 17%;"> </td>
</tr>
<tr>
<td colspan="8" style="width: 17%;">
<span style="font-size: x-small; font-family: verdana, geneva;">Oświadczam, że na terenie nieruchomości wskazanej
w części C niniejszej deklaracji odpady komunalne
gromadzone są w pojemnikach/workach:</span>
</td>
</tr>
<tr>
<td colspan="8" style="width: 17%;"> </td>
</tr>
<tr>
<td style="width: 17%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> </strong>
</span>
</td>
<td style="width: 17%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Ilość pojemników na nieruchomości</strong>
</span>
</td>
<td style="width: 5%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> </strong>
</span>
</td>
<td style="width: 17%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Miesięczna liczba odbiorów</strong>
</span>
</td>
<td style="width: 5%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> </strong>
</span>
</td>
<td style="width: 17%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Stawka opłaty</strong>
</span>
</td>
<td style="width: 5%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; border-right: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong> </strong>
</span>
</td>
<td style="width: 17%; background-color: #e2e2e2; border-bottom: 1px solid #000000; border-top: 1px solid #000000; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Iloczyn ilości pojemników i stawki
opłaty</strong>
</span>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Worek 120 L</span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID68"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID69"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID70"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID71"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Pojemnik 110 L</span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID72"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID73"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID74"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID75"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Pojemnik 120 L</span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID76"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID77"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID78"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID79"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Pojemnik 140 L</span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID80"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID81"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID82"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID83"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
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<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
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<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
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<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
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<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Pojemnik 240 L</span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
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</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
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</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
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</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
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<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
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<span type="text">
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</span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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<td style="width: 17%; text-align: center;">
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<td style="width: 17%; text-align: center;">
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</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">Pojemnik 1100 L</span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
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</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
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<td style="width: 5%; text-align: center;">
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</td>
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<td style="width: 5%; text-align: center;">
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<tr>
<td style="width: 17%; text-align: center;">
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</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">kontener 5m<sup>3<br/></sup></span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
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</span>
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
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<span>
<label>
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<xsl:if test="true()">
<span type="text">
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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<span>
<label>
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
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<td style="width: 17%; text-align: center;">
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</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
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</td>
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</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">kontener 7m<sup>3<br/></sup></span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
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</td>
<td style="width: 17%; text-align: center;">
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
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</td>
<td style="width: 17%; text-align: center;">
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</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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</strong>
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<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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</td>
<td style="width: 17%; text-align: center;">
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</strong>
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<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">kontener 9m<sup>3<br/></sup></span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
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<xsl:if test="true()">
<span type="text">
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</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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<label>
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<xsl:if test="true()">
<span type="text">
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</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
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<span type="text">
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</span>
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</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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</span>
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</span>
</span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
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</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;"> </span>
</strong>
</td>
</tr>
<tr>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">kontener 10m<sup>3<br/></sup></span>
</strong>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
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</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID104"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
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</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID105"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">X</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID106"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 17%; text-align: center;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
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</span>
</xsl:if>
</span>
</span>
</strong>
</td>
</tr>
<tr>
<td colspan="8" style="width: 17%; border-top: 1px solid #000000;"> </td>
</tr>
<tr>
<td colspan="7" style="width: 17%;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Wysokość opłaty miesięcznej za
gospodarowanie odpadami komunalnymi
wynosi:</strong>
</span>
</td>
<td style="width: 17%;">
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID108"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</td>
</tr>
<tr>
<td colspan="8" style="width: 17%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Słownie: <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID109"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td colspan="8" style="width: 17%; border-bottom: 1px solid #000000;"> </td>
</tr>
<tr>
<td style="width: 17%;"> </td>
<td style="width: 17%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 17%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 17%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 17%;"> </td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="background-color: #e2e2e2; width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>F. DOTYCZY WŁAŚCICIELI NIERUCHOMOŚCI, KTÓRYCH
CZĘŚĆ NIERUCHOMOŚCI STANOWI NIERUCHOMOŚĆ, O KTÓREJ
MOWA W CZĘŚCI „D” ORAZ „E”</strong>
</span>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="5" style="width: 30%;">
<span style="font-size: x-small; font-family: verdana, geneva;">Oświadczam, że na terenie nieruchomości,
wskazanej w części C niniejszej deklaracji, odpady
powstają w sposób określony w części D oraz
E:</span>
</td>
</tr>
<tr>
<td colspan="5" style="width: 30%;"> </td>
</tr>
<tr>
<td colspan="5" style="width: 30%;">
<span style="font-size: x-small; font-family: verdana, geneva;">
<strong>Wysokość miesięcznej opłaty za
gospodarowanie odpadami komunalnymi</strong>
</span>
</td>
</tr>
<tr>
<td style="width: 30%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 30%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 30%;"> </td>
</tr>
<tr>
<td style="width: 30%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID110"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">+</span>
</td>
<td style="width: 30%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID111"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
<td style="width: 5%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">=</span>
</td>
<td style="width: 30%; text-align: center;">
<p>
<strong>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:if test="true()">
<span type="text">
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID112"/>
</span>
</xsl:if>
</span>
</span>
</strong>
</p>
</td>
</tr>
<tr>
<td style="width: 30%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(suma z części D)</span>
</td>
<td style="width: 5%; text-align: center;"> </td>
<td style="width: 30%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(suma z części E)</span>
</td>
<td style="width: 5%; text-align: center;"> </td>
<td style="width: 30%; text-align: center;">
<span style="font-size: x-small; font-family: verdana, geneva;">(suma części D i E)</span>
</td>
</tr>
<tr>
<td style="width: 30%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 30%;"> </td>
<td style="width: 5%;"> </td>
<td style="width: 30%;"> </td>
</tr>
<tr>
<td colspan="5" style="width: 30%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Słownie: <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID121"/></span></xsl:if></span></span>
</p>
</td>
</tr>
<tr>
<td colspan="5" style="width: 30%;"> </td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="background-color: #e2e2e2; width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>G. OPŁATA ZA GOSPODAROWANIE ODPADAMI KOMUNALNYMI
DOTYCZY WŁAŚCICIELI NIERUCHOMOŚCI, NA KTÓRYCH
ZNAJDUJĄ SIĘ DOMKI LETNISKOWE LUB INNE NIERUCHOMOŚCI
WYKORZYSTYWANE NA CELE REKREACYJNO –
WYPOCZYNKOWE</strong>
</span>
<br/>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="width: 50%; border-right: 1px solid #000000;">
<span style="font-size: x-small; font-family: verdana, geneva;">Ryczałtowa roczna stawka opłaty za gospodarowanie
odpadami komunalnymi z nieruchomości wskazanej w
dziale C</span>
</td>
<td style="width: 50%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <strong><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID122"/></span></xsl:if></span></strong>
<strong>zł</strong></span>
</p>
</td>
</tr>
<tr>
<td colspan="2" style="width: 50%; border-top: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Wysokość rocznej opłaty ryczałtowej za
gospodarowanie odpadami komunalnymi wynosi:
<strong><span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID123"/></span></xsl:if></span>zł</strong></span>
</p>
</td>
</tr>
<tr>
<td colspan="2" style="width: 50%; border-top: 1px solid #000000;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Słownie: <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID124"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="background-color: #e2e2e2; width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<span style="font-size: small; font-family: verdana, geneva;">
<strong>H. ZAŁĄCZNIKÓW</strong>
</span>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<xsl:for-each select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID9">
<xsl:if test="true()">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="background-color: #ffffff; width: 50%;">
<span style="font-size: x-small; font-family: verdana, geneva;">Opis załącznika:
<span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID10"/></span></xsl:if></span></span>
</td>
<td style="background-color: #ffffff; width: 50%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">
<span>
<label>
<span/>
</label>
<xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID11/../@nazwaPliku"/>
</span>
</span>
</p>
</td>
</tr>
</tbody>
</table>
</xsl:if>
</xsl:for-each>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="background-color: #e2e2e2; width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<p>
<strong>
<span style="font-size: small; font-family: verdana, geneva;">I. OŚWIADCZENIE I PODPIS SKŁADAJĄCEGO
DEKLARACJĘ</span>
</strong>
</p>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<span style="font-size: x-small; font-family: verdana, geneva;">Oświadczam, że podane w deklaracji dane są zgodne ze
stanem faktycznym</span>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="width: 100%; border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;" valign="middle">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td style="width: 50%; border-right: 1px solid #000000; text-align: left;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Imię</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID33"/></span></xsl:if></span></span>
</p>
</td>
<td style="width: 50%; text-align: left;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> Nazwisko</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID34"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td align="left" colspan="3" style="background-color: #ffffff; width: 34%; border-style: solid; border-width: 0px 1px 1px; border-color: #000000;" valign="middle">
<table border="0" cellpadding="0" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td colspan="2" style="width: 50%;">
<p>
<span style="font-size: x-small; font-family: verdana, geneva;">Data wypełniania deklaracji</span>
</p>
<p>
<span style="font-size: x-small; font-family: verdana, geneva;"> <span><label><span/></label><xsl:if test="true()"><span type="text"><xsl:value-of select="wnio:TrescDokumentu/wnio:Wartosc/wnio:ID35"/></span></xsl:if></span></span>
</p>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
</div>
<div> <table border="0" cellpadding="0" cellspacing="0" style="width: 100%;"><tbody><tr><td style="background-color: #e2e2e2; border-style: solid; border-width: 1px; border-color: #000000;"><strong><span style="font-size: small; font-family: verdana, geneva;">J. ADNOTACJE
ORGANU</span></strong></td></tr><tr><td style="border-right-style: solid; border-bottom-style: solid; border-left: 1px solid #000000; border-right-width: 1px; border-bottom-width: 1px; border-right-color: #000000; border-bottom-color: #000000;"><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p></td></tr></tbody></table></div>
<table align="right">
<tr>
<td style="width: 100%;">
<p/>
<p/>
<p align="right" style="text-align: left;font-size: small;font-family: verdana, geneva;line-height: 20px;">
<xsl:choose>
<xsl:when test="string-length(//wnio:Dokument/ds:Signature/ds:SignatureValue) > 0">
<xsl:text>Dokument został podpisany, aby go zweryfikować należy użyć oprogramowania do weryfikacji podpisu </xsl:text>
<br/>
<xsl:for-each select="//wnio:Dokument/ds:Signature/ds:Object">
<xsl:if test="descendant::*[local-name() = 'SigningTime']">
<xsl:value-of select="descendant::*[local-name() = 'SigningTime']"/>
</xsl:if>
<br/>
<xsl:choose>
<xsl:when test="descendant::*[local-name() = 'PodpisZP']">
Podpis profilem zaufanym: <xsl:value-of select="descendant::*[local-name() = 'Imie']"/><xsl:text> </xsl:text><xsl:value-of select="descendant::*[local-name() = 'Nazwisko']"/><br/></xsl:when>
</xsl:choose>
</xsl:for-each>
</xsl:when>
<xsl:otherwise>
<xsl:text>Dokument nie zawiera podpisu</xsl:text>
</xsl:otherwise>
</xsl:choose>
<br/>
</p>
</td>
</tr>
</table>
</body>
</html>
</xsl:for-each>
</xsl:template>
</xsl:stylesheet>