Постановление Правительства Калининградской области от 05.05.2011 № 303

|      | претендентов |   изъявивших    |                                                                                     | молодой семье,  |   семьи из   |
|      | на получение |     желание     |                                                                                     |     рублей      |    списка    |
|      |  социальных  |    получить     |                                                                                     |                 |   молодых    |
|      |   выплат в   |   социальную    |                                                                                     |                 |   семей -    |
|      |  20___ году  |    выплату в    |                                                                                     |                 | претендентов |
|      |              |   планируемом   |                                                                                     |                 | на получение |
|      |              |      году       |                                                                                     |                 |  социальных  |
|      |              | (сформированный |                                                                                     |                 |   выплат в   |
|      |              |     органом     |                                                                                     |                 |  20__ году   |
|      |              |    местного     |                                                                                     |                 |              |
|      |              | самоуправления  |                                                                                     |                 |              |
|      |              |   МО КО до 01   |                                                                                     |                 |              |
|      |              |    сентября     |                                                                                     |                 |              |
|      |              | предшествующего |                                                                                     |                 |              |
|      |              |      года)      |                                                                                     |                 |              |
+------+--------------+-----------------+---------------+-------------+-------------+----------------------+-----------------++----------------++--------------+
|      |              |                 |  Члены семьи  | Родственные |   Число,    |   Данные паспорта    |     Данные      |                 |               |
|      |              |                 |   (Ф.И.О.)    |  отношения  | месяц, год  |      гражданина      | свидетельства о |                 |               |
|      |              |                 |               |  (супруг,   |  рождения   | Российской Федерации |      браке      |                 |               |
|      |              |                 |               |  супруга,   |             | или свидетельства о  |                 |                 |               |
|      |              |                 |               | сын, дочь)  |             |       рождении       |                 |                 |               |
|      |              |                 |               |             |             | несовершеннолетнего, |                 |                 |               |
|      |              |                 |               |             |             | не достигшего 14 лет |                 |                 |               |
+------+--------------+-----------------+---------------+-------------+-------------+-----------+----------+--------+-------++----------------++---------------+
|      |              |                 |               |             |             |  серия,   |   кем,   | серия, | кем,  |                 |                |
|      |              |                 |               |             |             |   номер   |  когда   | номер  | когда |                 |                |
|      |              |                 |               |             |             |           |  выдан   |        | выдан |                 |                |
+------+--------------+-----------------+---------------+-------------+-------------+-----------+----------+--------+-------+-----------------+----------------+
|  1   |      2       |        3        |       4       |      5      |      6      |     7     |    8     |   9    |  10   |       11        |       12       |
+------+--------------+-----------------+---------------+-------------+-------------+-----------+----------+--------+-------+-----------------+----------------+
|  +   |              |                 |               |             |             |           |          |        |       |                 |                |
+------+--------------+-----------------+---------------+-------------+-------------+-----------+----------+--------+-------+-+---------------+-+--------------+
|                                                                                                                       Итого |                 |      -       |
+-----------------------------------------------------------------------------------------------------------------------------+-----------------+--------------+
|                                                                         Из них за счет средств федерального бюджета, рублей |                 |      -       |
+-----------------------------------------------------------------------------------------------------------------------------+-----------------+--------------+
|                                                                           Из них за счет средств областного бюджета, рублей |                 |      -       |
+-----------------------------------------------------------------------------------------------------------------------------+-----------------+--------------+
|                                                                             Из них за счет средств местного бюджета, рублей |                 |      -       |
+-----------------------------------------------------------------------------------------------------------------------------+-----------------+--------------+

2. Предложения по дополнительно включенным в список молодых семей -
претендентов на получение социальных выплат:
+------+--------------------+-------------------------------------------------------------------------------------+-----------------+---------------+
|  №   |   Номер в списке   |              Сведения о членах молодой семьи - участника подпрограммы               |     Размер      |   Основания   |
| п/п  |  молодых семей -   |                                                                                     |   социальной    |   (причины)   |
|      |     участников     |                                                                                     |    выплаты,     |   включения   |
|      |   подпрограммы,    |                                                                                     | предоставляемой | молодой семьи |
|      | изъявивших желание |                                                                                     | молодой семье,  |   в список    |
|      |      получить      |                                                                                     |     рублей      | молодых семей |
|      | социальную выплату |                                                                                     |                 | -претендентов |
|      | в планируемом году |                                                                                     |                 | на получение  |
|      |  (сформированный   |                                                                                     |                 |  социальных   |
|      |  органом местного  |                                                                                     |                 | выплат в 20__ |
|      | самоуправления МО  |                                                                                     |                 |     году      |
|      | КО до 01 сентября  |                                                                                     |                 |               |
|      |  предшествующего   |                                                                                     |                 |               |
|      |       года)        |                                                                                     |                 |               |
+------+--------------------+-------------+-------------+-------------+----------------------+-------------------++----------------++---------------+
|      |                    | Члены семьи | Родственные |   Число,    |   Данные паспорта    |      Данные       |                 |                |
|      |                    |  (Ф.И.О.)   |  отношения  | месяц, год  |      гражданина      |  свидетельства о  |                 |                |
|      |                    |             |  (супруг,   |  рождения   | Российской Федерации |       браке       |                 |                |
|      |                    |             |  супруга,   |             | или свидетельства о  |                   |                 |                |
|      |                    |             | сын, дочь)  |             |       рождении       |                   |                 |                |
|      |                    |             |             |             | несовершеннолетнего, |                   |                 |                |
|      |                    |             |             |             | не достигшего 14 лет |                   |                 |                |
+------+--------------------+-------------+-------------+-------------+-----------+----------+--------+----------+-----------------+----------------+
|      |                    |             |             |             |  серия,   |   кем,   | серия, |   кем,   |                 |                |
|      |                    |             |             |             |   номер   |  когда   | номер  |  когда   |                 |                |
|      |                    |             |             |             |           |  выдан   |        |  выдан   |                 |                |
+------+--------------------+-------------+-------------+-------------+-----------+----------+--------+----------+-----------------+----------------+
|  1   |         2          |      3      |      4      |      5      |     6     |    7     |   8    |    9     |                 |       13       |
+------+--------------------+-------------+-------------+-------------+-----------+----------+--------+----------+-----------------+----------------+
|  +   |                    |             |             |             |           |          |        |          |                 |                |
+------+--------------------+-------------+-------------+-------------+-----------+----------+--------+----------++----------------++---------------+
|                                                                                                           Итого |                 |       -       |
+-----------------------------------------------------------------------------------------------------------------+-----------------+---------------+
|                                                             Из них за счет средств федерального бюджета, рублей |                 |       -       |
+-----------------------------------------------------------------------------------------------------------------+-----------------+---------------+
|                                                               Из них за счет средств областного бюджета, рублей |                 |       -       |
+-----------------------------------------------------------------------------------------------------------------+-----------------+---------------+
|                                                                 Из них за счет средств местного бюджета, рублей |                 |       -       |
+-----------------------------------------------------------------------------------------------------------------+-----------------+---------------+



Глава (глава администрации)
муниципального образования __________________ _____________
___________________
   М.П. (наименование МО КО) (подпись) (расшифровка подписи)



Ф.И.О., телефон исполнителя:______________________________________