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E f v x Eձ } T | 0 8 Z @ 4 R 9 E E } $ C e r t i f i e d b y t h e M i n i s t r y o f L a b o u r a n d S o c i a l P o l i c y o f U k r a i n e a s o f 2 7 . 0 8 . 2 0 0 4 ! _ _ _ T h e o w n e r o f a n e n t e r p r i s e , i n s t i t u t i o n , o r g a n i z a t i o n o r p e r s o n a u t h o r i z e d b y h i m ( e d u c a t i o n a l e s t a b l i s h m e n t ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________ or natural person entrepreneur_____________________________________________________ name Location____Volochysk___________ tel. ______ Identification Code under the CSREOU (Common State Register of Enterprises and Organizations of Ukraine)_______________________________________________________ or registration number from SRTAU (State Regional Tax Administration of Ukraine) _________ State Tax Inspectorate____________________________________________________________ INCOME CERTIFICATE Issued to the citizen _______________________________________________________ that she really works/studies in ____________________________________________________ the form of employment (study)_________________________ __________________________ work status_________________________________obstetrician__________________________ Personal identification number_____________________________________________________ Months of 2010Salary calculated in natural UAHOther calculations in natural UAHMaintenanceSalary calculated in USDJanuaryFebruaryMarchAprilMayJuneJuly AugustSeptember Total: Total income for the period from 1.01.2010 to 8.09.2010 except maintenance is: _____________________________________________________________________________ in written _______________________________________________________________________________________________________ Certificate issued for presentation to the labor and social security bodies for the social assistance issuance (housing subsidiary). Under the absence in the natural person entrepreneur the seal, the copy of state registration certificate is added. 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