Lisa 1 
Kadrina Vallavolikogu
30.03.2016 määruse
nr 59 juurde

Eluruumi taotlemise avaldus
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1. Taotleja andmed:

Ees- ja perekonnanimi ......................................................................................................................

Isikukood ..........................................................................................................................................

Elukoha  aadress ...............................................................................................................................

Muud kontaktandmed .......................................................................................................................

2. Vajan eluruumi sellepärast, et .......................................................................................................

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3. Perekonna kuusissetulekud:

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4. Perekonna kuu väljaminekud

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5. Perekonna/leibkonna liikmed
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6. Olen nõus minu isikuandmete, sh delikaatsete isikuandmete kontrollimise ja töötlemisega.

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taotleja allkiri