background image

 

 (dot. tylko wniosków innych jednostek niż PSP) 

................................................. 

     

 

                  (pieczęć nagłówkowa KP/KM PSP )  
 

...................................., dnia ...................... r.

 

 

 

 

 

Komendant Główny  
Państwowej Straży Pożarnej 

ul. Podchorążych 38 
00 – 463 Warszawa 

 
za pośrednictwem  

 

...................................................... 
Komendanta Wojewódzkiego 

Państwowej Straży Pożarnej 
.................................. 

.................................. 

 

 

Opinia  

 
 

...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

........................................................................................................................................................................... 
...........................................................................................................................................................................

...........................................................................................................................................................................
...........................................................................................................................................................................

...........................................................................................................................................................................
........................................................................................................................................................................... 

 
 

        ................................................... 

 

 

 

 

  

 

 

 

 

 (pieczątka i podpis Komendanta Powiatowego/Miejskiego PSP)