IZB1

P R I J E D L O G KANDIDATKINJE/KANDIDATA I
ZAMJENIKA KANDIDATKINJE/KANDIDATA
ZA PREDJESNIKA,
POTPREDSJEDNIKA
ILI ZAMJENIKA PREDSJEDNIKA RAZREDA

za

______________________________________________________________________________________________________________________________________________________________________________________________ (predsjednika ,
potpredsjednika ili zamjenika)

__________________________________________________________________________________________________________________________________________________________________________________________________ (naziv razrednog

odijeljenja)

PREDLAGATELJ:
__________________________________________________________________________________________________________________________________________________________________________________________________ (naziv kandidata)
__________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________

KANDIDATKINJA/KANDIDAT
Ime i prezime

___________________________________________________________

Adresa prijavljenog prebivalita

Datum roenja

_________________________

OIB

Spol M

__________________________________________________________________________________________________________________________________________________________

ZAMJENIK KANDIDATKINJE/KANDIDATA
Ime i prezime

___________________________________________________________

Adresa prijavljenog prebivalita

Datum roenja

_________________________

OIB

Spol M

__________________________________________________________________________________________________________________________________________________________

ZAMJENIK KANDIDATKINJE/KANDIDATA
Ime i prezime

___________________________________________________________

Adresa prijavljenog prebivalita

Datum roenja

_________________________

OIB

Spol M

__________________________________________________________________________________________________________________________________________________________

Sastavni dio ovog prijedloga je propisani obrazac potpisa biraa koji podravaju kandidaturu (OLN-3) s podacima i u broju utvrenim u
l. 10. st. 4. i l. 12. st. 1. Zakona o lokalnim izborima (Narodne novine, broj 144/12, dalje: Zakon).

___________________________________________________________________ (mjesto
i datum)

______________________________________________________________________________________________________________
______________________________________________________________________________________________________________

______________________________________________________________________________________________________________ (potpis ovlatenog predstavnika politike stranke, odnosno ovlatenih predstavnika dviju ili vie politikih
stranaka