Upravni odjel za ___________

KLASA: __________________________
UR.BROJ: _________________________
Slavonski Brod, ________2016. godine
MB:_________________________

ZAPISNIK

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( Kada, gdje i u kojoj je upravnoj stvari raspravljano )

Započeto u _____ sati.

Nazočni :
Voditelj postupka-zapisničar Stranka
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Sadržaj zapisnika :
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( izjave stranaka,isprave, zaključci )

Zapisnik je pročitan stranci i ________ primjedbi.

Završeno u ______ sati.

Službena osoba: Stranka

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(potpis) (potpis)

Prilog :