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DAJE ODAGOVNKOVI Priezvisko a titul 01Meno Rodn slo (U cudzch at. prsluankov dtum narodenia.) 02  03 / Adresa trvalho pobytu alebo pobytu na zem SR, kde sa daHovnk obvykle zdr~iaval Ulica a slo 04PS  Nzov obce 0506`tt 07 slo telefnu 08 Suma do vaky 2 % zaplatenej dane 09Zaplaten daH, zktorej sa vypo ta suma do vaky 2 % zaplatenej dane10Suma do vaky 2 % zo zaplatenej dane zr. 09 (min. 3,32 eura)Na r. 09 sa uvdza daHov povinnose daHovnka, zn~en odaHov bonus, vypo tan v roku (nie daH na hradu), vktorom sa podva toto vyhlsenie; uvdza sa riadok 03 z potvrdenia ozaplaten dane, ktor je s aseou tohto vyhlsenia. 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Dtum zaplatenia dane 11Z riadku 05 potvrdenia ozaplaten dane, ktor je s aseou vyhlsenia. Vprpade daHovho preplatku zro nho z tovania preddavkov na daH sa uvedie dtum 31. marec zdaHovacieho obdobia, vktorom sa toto vyhlsenie podva. II. DAJE O PRIJMATE=OVI Obchodn meno alebo nzov 12 VYDRA  vidiecka rozvojov aktivitaSdlo  obec, PS , ulica, slo 13 ierny Balog, 976 52, Hlavn 56Prvna forma Identifika n slo prijmate>a (I O/SID) 14 Ob ianske zdru~enie1535980672" Vyhlasujem, ~e uveden daje v tomto vyhlsen s pravdiv. V................................................ dHa............................... ....................................................... 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