Návrh laureáta na udelenie

CENY MESTA / CENY PRIMÁTORA MESTA*1
STARÁ ĽUBOVŇA

N a v r h o v a n ý   l a u r e á t

A.  	j e d n o t l i v e c
Meno a priezvisko:		__________________________________________
Dátum narodenia:		__________________________________________
Bydlisko: 			__________________________________________

B.  	k o l e k t í v
Názov: 			__________________________________________
Vedúci: 			__________________________________________
Sídlo: 				__________________________________________

O d ô v o d n e n i e   n á v r h u  :
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

N á v r h   p r e d l o ž i l
Meno a priezvisko: 		__________________________________________
Bydlisko:			__________________________________________
Tel. kontakt: 			__________________________________________
Podpis: 			__________________

N á v r h   p r e v z a l  
Meno a priezvisko: 		__________________________________________
Dátum:			__________________
Podpis: 			__________________

_________________________________________________________________
*1 nehodiace sa preškrtnúť
    vyplnené odovzdať v kancelárii primátora mesta a prednostu MsÚ