Návrh laureátana udelenie

CENY MESTA / CENY PRIMÁTORA MESTA*1
STARÁ ĽUBOVŇA

Na v rho v a nýla u reát

A. 	jednotlivec
Meno a priezvisko:		__________________________________________
Dátum narodenia:		__________________________________________
Bydlisko: 			__________________________________________

B. 	kolektív
Názov: 			__________________________________________
Vedúci: 			__________________________________________
Sídlo:				__________________________________________

O dôv o dneni e   n á v r h u :
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Návrh predložil
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 odovzdaťv kancelárii primátora mesta a prednostu MsÚ