inny 1,1 P

Transkrypt

inny 1,1 P
!"#$%&'#'()#$*+,!"%!"%'-.*%/".01 ',# ".*# %2#'3.$#4('2%#)%356!%2#'"'&./*#2/.7"83!%2#1
#79#IC2J#2#."(+2-;%KL"(+"#+.2%-;% "+0/
#F9#G2)B-0%+%4H#2# "&"
Formularz
P
, dnia
6. O ')-"&#+.2%-;E#P#."(+"#2#" ')-#%'5".E#!E*#B) .%-&;2#%'5".2("0/B.)B6#;&<'"#
+#2C2).2E#%'5".E#$'%+" (2#$"Q-&+%+/#("-<*#5)% )(/B./#2#;"'&%5'"A20(./
2. Adres miejsca zamieszkania/siedziby wnioskodawcy
!" #$%&'$(%)( *%)+,-. %&/&%( 01$($ *%)+,-+/&*'23
7. Oznaczenie kancelaryjne wniosku nadane przez adresata wniosku
4. Dane kontaktowe wnioskodawcy: numer telefonu/adres poczty elektronicznej*
!"#$%&'#()*+$+,-#.+/$%)*!.01
8. Przedmiot wniosku
Baza danych geodezyjnej ewidencji siecii uzbrojenia terenu (GESUT) 6
4" #-1(56(%)( 7&8(1)&9:* $&,+;. ;2/<'='> 01$(/7)+8(7 *%)+,-.
?;):1 /&%='> (*)/(%'@) A1.%8:* ) ;./=%-:*
2
B&$& /&%='> ,$'$(A:9+*='> +,%:* A(+/($=@%='> CBDE#FG7
Rejestry, kartoteki, skorowidze, wykazy, zestawienia tworzone na
@"("# "./01#%*2);&<+#&%$%5'"A20(./016#%#;&<')B#C%+"#+#"'&9#D#E-&9#7*#
podstawie bazy danych EGiB3
ustawy12 (BDOT500)8
H&0& (*)/(%'@) A1.%8:* ) ;./=%-:*
4
Mapa zasadnicza9
5
J%%( 7&8(1)&9=10:
I(@(,81 '(% ) *&18+5') %)(1.'>+7+5')
K" L&1&7(81= '>&1&-8(1=$.@<'( $&-1(, .01&*%)(M /+ 01$(8*&1$&%)& 7&8(1)&9:* $&,+;. 11
."#0)!)#2#$% C2%&%C6#%#;&<'/01#C%+"#
w art. 40a ust. 2 pkt 2 ustawy12
7!.489:(
;#<5=*+$'')"!(CL
!"#$%&'()*#+,"-./01#.2)(+23("./01##
(# (2","!.%4023#5%-$% "'0(36#*)(#
prawa publikacji w sieci Internet;
/6& 0+81$(; $*)<$&%='> $ /$)&9&6%+5')< A+,0+/&1'$< 6.; * '(6. 0.;6)-&'@) +01&'+*&M -&18+A1&X)'$%='> Y 0+'>+/%='>
7&8(1)&9:* $&,+;. * ,)(') J%8(1%(8 $A+/%)( $ 0+%)Z,$< 8&;(6<
!"#$%&'()*%'(+$%&$(),(-&-./)01($%"2&+/3
!"#$%!&'!(&)*+,!(-.+/0+123('!("45.$*6(
%8>/(,$:(<.+14;!.+!'1(%!41.)!=$(+!#8,("8<))(1&1"4.8')*+'$*6(%!41.)!=5;(+!#8,-(&-,
((&-,(8<.!*8;!')!(("!.48>.!?)*+'1(@(<8*680'1
(8<.!*8;!2("!.48>.!?)*+'$*6(@(<8*680'$*6
C<8#5,(<-,&)"!*D)
w sieci Internet
(%!41.)!=5;(+!#8,-3(8("45.$*6(%8;!(;(-#4A(B
%!41.)!=5;(+!#8,-3(8("45.$*6(%8;!(;(-#4A(B
(<"4(E(+!=/*+')"!(08(-#4!;$12, w przeliczeniu
(<"4(E(+!=/*+')"!(08(-#4!;$123(+(;$=/*+1')1%
publikacji w sieci Internet
na arkusze formatu A4
Pojedynczy obraz statyczny
1,1
10
500
o rozmiarze maksimum do
1 000 000 pikseli
1,2
100
1,3
500
2 000
5 000
1,4
1 000
10 000
1,7
10 000
50 000
2,0
60 000
200 000
2,5
200 000
500 000
3,0
B($ +A1&%)'$(M
B($ +A1&%)'$(M
Pojedynczy obraz statyczny
o rozmiarze maksimum do
2 100 000 pikseli
B($ +A1&%)'$(M
#789#:-%*"#+/(."0(%."# %#;%.&";&<+#()#-&'%./#+.2%-;% "+0/=
J7)2N %&$*),-+O
e-mail:
telefon:
44" P+17& 01$(-&$&%)& ) ,0+,:; +/;)+1. 7&8(1)&9:*
0+,8&Q %)((6(-81+%)'$%&
E0+,:; ./+,820%)(%)&O
+/;):1 +,+;),8=
0+,8&Q (6(-81+%)'$%&
serwer FTP/e-mail
*=,=9-& %& &/1(,O
09=8& RDSDTD
@&- * %&A9:*-.
%+5%)- $(*%281$%= *%)+,-+/&*'=
inny
.,9.A& ,)(')+*& ./+,820%)&%)&
.,9.A&13N + -8:1(@ 7+*& * .,8" UV $&9<'$%)-& /+ .,8&*=12:
1 rok
W 7)(,)2'=
! 7)(,)<'(
e-mail:
serwer FTP:
#7M9#N% "&;%+)#+/B"4.2).2"#2#E+"52#+.2%-;% "+0/
WNIOSKODAWCA
J7)2N %&$*),-+ +1&$ 0+/0), *%)+,-+/&*'=14
Przypisy:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
!"#$%&'(+)#)&0;4&3!*+)9#6;D:!='A)%&;+$*&>&'A):#-*&;#-+C#)/&6#,4)C+#9+/=(!+C#)*)0&$;#C$&"*'/!+C#)49#6;D:!*&)#$C&!):$#-&9/.'=);+!)/&6@,1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)/,*#$4)9&!='A)NL*H)/&-*+$&)"#$%43&$/)2O1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)$+(+6;$@-?)0&$;#;+0?)60#$#-*9/@-?)-=0&/@-?)/+6;&-*+E);-#$/#!='A)!&):#96;&-*+),&/=)9&!='A)NL*H)/&-*+$&)"#$%43&$/)2P1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)%&:=)+-*9+!'(*)C$4!;@-)*),49=!0@-)/&-*+$&)"#$%43&$/)2Q1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)$+(+6;$4)'+!)*)-&$;#8'*)!*+$4'A#%#8'*)/&-*+$&)"#$%43&$/)2R1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)/,*#$@-)9&!='A)LNJFS)/&-*+$&)"#$%43&$/)2T1
F6/'/+C@>#-*+!*+)-!*#604)#)/,*#$@-)9&!='A)HIJKL)/&-*+$&)"#$%43&$/)2M1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)/,*#$@-)9&!='A),&/=)9&!='A)HIKSTYY)/&-*+$&)"#$%43&$/)2U1
F6/'/+C@>#-*+!*+)-!*#604)#)49#6;D:!*+!*+)%&:=)/&6&9!*'/+()/&-*+$&)"#$%43&$/)2Q1
F6/'/+C@>#-*+!*+)-!*#604)#)#)49#6;D:!*+!*+)*!!='A)%&;+$*&>@-)/&-*+$&)"#$%43&$/)2G1
Dopuszczalne jest wskazanie tylko jednego celu.
F6;&-&)/)9!*&)OU)%&(&)OVGV)$1)W)2$&-#)C+#9+/=(!+)*)0&$;#C$&"*'/!+)XI/1)F1)/)PYOY)$1)Z$)OVQ?):#/1)OPGU?)/):@[!1)/%1\1
F9#6;D:!*+!*+)-)"#$%*+)#0$+6#-+()46>4C*)6*+'*#-+()%&)/&6;#6#-&!*+)-):$/=:&904)49#6;D:!*&!*&)#$;#"#;#%&:=)34,)#:$&'#-&E)0&$;#C$&"*'/!='A?);-#$/#!='A)!&):#96;&-*+)#9:#-*+9!*'A),&/)9&!='A?)#)0;@$='A)
mowa w art. 4 ust. 1a pkt 1-3, 7, 8, 10, 11 lub ust. 1b ustawy - Prawo geodezyjne i kartograficzne.
14. 2#9:*6)#9$D'/!=?):#9:*6)+3+0;$#!*'/!=?)#)0;@$=%)%#-&)-)&$;1)Q):0;)O)46;&-=)/)9!*&)OG)-$/+8!*&)PYYO)$1)#):#9:*6*+)+3+0;$#!*'/!=%)XI/1)F1)/)PYOQ)$1):#/1)PMP\?),+/:*+'/!=):#9:*6)+3+0;$#!*'/!=?)#)0;@$=%)%#-&)-)
&$;1)Q):0;)P)46;&-=)/)9!*&)OG)-$/+8!*&)PYYO)$1)#):#9:*6*+)+3+0;$#!*'/!=%?):#9:*6):#;-*+$9/#!=):$#"*3+%)/&4"&!=%)+2F]2?)#)0;@$=%)%#-&)-)&$;1)Q):0;)OT)46;&-=)/)9!*&)OU)34;+C#)PYYT)$1)#)*!"#$%&;=/&'(*)
9/*&>&3!#8'*):#9%*#;@-)$+&3*/4(.'='A)/&9&!*&):4,3*'/!+)XI/1)F1)/)PYOQ)$1):#/1)PQT?)/):@[!1)/%1\?)34,)-):$/=:&904)60>&9&!*&)-!*#604)/&):#%#'.)6=6;+%4);+3+*!"#$%&;='/!+C#?)#)0;@$=%)%#-&)-):$/+:*6&'A)
-=9&!='A)!&):#96;&-*+)&$;1)RY)46;1)G)46;&-=)W)2$&-#)C+#9+/=(!+)*)0&$;#C$&"*'/!+?)*9+!;="*0&;#$)4%#53*-*&(.'=)-+$="*0&'(D)-!*#60#9&-'=)-);=%)6=6;+%*+1
*
!"#$%&'(&)!*+#,#-*./0#-&1
!"#$%&'%&#(
1. B#$%43&$/+)9$40#-&!+)!*+)%46/.)4-/C3D9!*&7)#/!&'/+E)0#3#$=6;='/!='A1
2. 2#3&)"#$%43&$/&)%#5!&)$#/6/+$/&7)-)/&3+5!#8'*)#9):#;$/+,1)<):$/=:&904)-=:+>!*&!*&)"#$%43&$/&)-):#6;&'*):&:*+$#-+()"#$%43&$/)%#5+),=7)4/4:+>!*&!=)/&>.'/!*0&%*)/&-*+$&(.'=%*)*!"#$%&'(+?)0;@$='A)!*+)%#5!&)
,=>#)/&%*+8'*7)-)"#$%43&$/41)))
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' %5-+6), 17.8&9 57%8 17.8&9 :;-<
P1
!"#$%&'()*%+,#$-.%/0(1
2'()*%3*&!+4(5657$-.%+,#$-.8
3!"#$
opisowych
geometrycznych
2'()*%+56$-&9-$%+&(,"!;%!7(+!#-$>#$-.8
3!"#$
dane opisowe
dane geometryczne
2'()*%+56$-&9-$%':+$#;)78
3!"#$
dane opisowe
dane geometryczne
2'()*%+,#$-.%/0(1%+56$-&9-$-.%3:#;6)7%<*,#(-&#$-.
2'()*%+,#$-.%+56$-&,-$-.%=5;,=(
2'()*%+,#$-.%/0(1%53(D57$-.%(%<!54!6*$-&#$-.%+56$-&,-$-.%;5#6:*)7%
:N$6;)7%<*:#657$-.
2'()*%+,#$-.%/0(1%53(D57$-.%(%<!54!6*$-&#$-.%+56$-&9-$-.%;5#6:*)7%
klasyfikacyjnych
2'()*%+,#$-.%+56$-&,-$%35+4(56)7%7$;,&,#$-.%7%/0(1
2'()*%+,#$-.%/0(1%+56$-&9-$%5'(!;6)78
jednostek ewidencyjnych
5'*?')7%!7(+!#-$>#$-.%
(##$-.@%#(!7$4(!#(5#$-.%7-&!A#(!>
B5+,6;57!%7$>,A#(!#(,8
1
%OE%I$;,&,#(!%(#6!*!D:%3*,7#!<5%7#(5D;5+,7-$@%7%3*&$3,+;:%<+$%7#(5D!;%5'!>4:>!%+5D6?3%+5%+,#$-.%(+!#6$J(;:>9-$-.%7",A-(-(!=,%=:'%7",+,>9-!<5%#(!*:-.545A-(9
%LE% *&!D6*&!##,%=5;,=(&,->,%&'(5*)7%+,#$-.%',&$%+,#$-.%/0(1%5'>?6$-.%7#(5D;(!4%
>!+#5D6;(%35+&(,":%6!*$65*(,=#!<5
>!+#5D6;(%35+&(,":%;*,>:%D65D57,#!%7%/0(1
G>!+#5D6;(%!7(+E@%5'*?'$%!7(+E@%+&(,";(%!7(+EH
(+!#6$J(;,65*$%3:#;6)7%<*,#(-&#$-.
5'D&,*%5;*!A=5#$%#,%&,"9-&#(;:%<*,J(-&#$4
C'D&,*%5;*!A=5#$%7%&,"9-&5#$4%3=(;:%7!;65*57$4%7%:;",+&(!%7D3)"E8
PL-2000
(##$4%+53:D&-&5#$4%3*&!&%5*<,#%3*57,+&9-$%&,D)'%FFEEFE
ID3)"*&?+#!%35=(<5#:%7%:;",+&(!%7D3)"E8
PL-2000
(##$4%+53:D&-&5#$4%3*&!&%5*<,#%3*57,+&9-$%&,D)'%FFFFE
%ME%B5+,6;57!%7$>,A#(!#(,%(%:7,<(%7#(5D;5+,7-$
WNIOSKODAWCA
2
%K4(?@%#,&7(D;5%5*,&%35+3(D%7#(5D;5+,7-$
Przypisy:
1. P#"-*9$/94-;+2.>$<-*-"2$/+2!,:!3#/1#$+2-$<-,5$/;#01212-"-'$+2-&(1@!'!012$!6<C5-<$/+2!,:2-'$"(6$4!3'2!5-'$/;#3#<=19'$B&(+5#'2$!6<C59'2$59'$/+2!,:2-'7$8$5#:2'$4&)94#3:(>$/$4!"($59'>$/+2!,:!3#/1#$'(,2$
/9:#)#.$2+5-&-,$4&#/+9$!&#)$/,:#)#.$4&)-42,9$4&#/#>$)$:5?&91@$/9/!3)2$,/?<$2+5-&-,$4&#/+9$/$3!,5C42-$3!$3#+91@$23-+59%2:(<=191@$/;#01212-"#$"(6$/;#3#<=1-B!$+2-&(1@!'!012=$!6<C5=$/+2!,:2-'7
2.
!342,$!3&C1)+9>$4!342,$-"-:5&!+21)+9>$!$:5?&9'$'!/#$/$#&57$E$4:5$F$(,5#/9$)$3+2#$FG$/&)-0+2#$HIIF$&7$!$4!342,2-$-"-:5&!+21)+9'>$6-)42-1)+9$4!342,$-"-:5&!+21)+9>$!$:5?&9'$'!/#$/$#&57$E$4:5$H$(,5#/9$)$3+2#$
FG$/&)-0+2#$HIIF$&7$!$4!342,2-$-"-:5&!+21)+9'>$4!342,$4!5/2-&3)!+9$4&!%2"-'$)#(%#+9'$- JK >$!$:5?&9'$'!/#$/$#&57$E$4:5$FL$(,5#/9$)$3+2#$FM$"(5-B!$HIIL$&7$!$2+%!&'#59)#1<2$3)2#;#"+!012$4!3'2!5?/$&-#"2)(<=191@$
)#3#+2#$4(6"21)+->$"(6$/$4&)94#3:($,:;#3#+2#$/+2!,:($)#$4!'!1=$,9,5-'($5-"-2+%!&'#591)+-B!>$!$:5?&9'$'!/#$/$4&)-42,#1@$/93#+91@$+#$4!3,5#/2-$#&57$NI$(,57$G$(,5#/9$O$ &#/!$B-!3-)9<+-$2$:#&5!B&#%21)+->$
23-+59%2:#5!&$('!*"2/2#<=19$/-&9%2:#1<C$/+2!,:!3#/19$/$59'$,9,5-'2-7
I$>,A#(!#(,8
1. A!&'("#&)-$3&(:!/#+-$+2-$'(,)=$(/)B"C3+2#.$!)+#1)-D$:!"!&9,591)+91@7
2.
!"#$%!&'("#&)#$'!*+#$&!),)-&)#.$/$)#"-*+!012$!3$4!5&)-67$8$4&)94#3:($/94-;+2#+2#$%!&'("#&)#$/$4!,5#12$4#42-&!/-<$%!&'("#&)$'!*-$69.$()(4-;+2#+9$)#;=1)+2:#'2$)#/2-&#<=19'2$2+%!&'#1<->$:5?&91@$+2-$'!*+#$69;!$
)#'2-012.$/$%!&'("#&)(7$$$
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' 5'6'$25),7 /852+2'/7 $/+5+,-1%),7 ,9/8%),7 %'$28,-': 2,+5%+.9&; .8 4+1$28,-' <8%9 18.9&; =>-?
P2
@+4-8 5'6'$250 (50.2),A
Kopia rejestru:
Kopia kartoteki:
, 4'*.9B %8/5'$-'
bez danych osobowych
<019./),
lokali
<019./),
lokali
Wykaz (skorowidz):
1%-8*'/ ',-1"
4+1B-+2),
C'$28,-'.-' %<-+5&%' 18.9&; +<6329&; =>-? 1D8A
gminy
powiatu
E+182/+,' ,968F.-'.-8A
J" K9/8%8.-' -.2'5'$0 458,.'(+ ,.-+$/+18,&97 , 45%9481/0 (19 ,.-+$'/ +<'6B06' 1+$234 1+ 18.9&; -1'.29L-/06M&9&; ,*8F&-&-'D8 D0< ,*8186M&'(+ .-'50&;+B+F&-M1
O" E8.' -1'.29L-/06M&' +<$%85 +<6329 ,.-+$/-'B
6'1.+$2/- 4+1%-8*0 2'592+5-8D.'(+
6'1.+$2/- 4+1%-8*0 /5860 $2+$+,8.' , =>-? G6'1.+$2/- ',-1"7 +<53<9 ',-1"7 1%-8*/- ',-1"H
N" E+182/+,' ,968F.-'.-8 - 0,8(- ,.-+$/+18,&9
WNIOSKODAWCA
2
IB-37 .8%,-$/+ +58% 4+14-$ ,.-+$/+18,&9
Przypisy:
1. A#"-*9$/94-;+2.>$<-*-"2$/+2!,:!3#/1#$+2-$<-,5$/;#01212-"-'$+2-&(1@!'!012$!6<B5-<$/+2!,:2-'$"(6$4!3'2!5-'$/;#3#<=19'$C&(+5#'2$!6<B59'2$59'$/+2!,:2-'7$8$5#:2'$4&)94#3:(>$/$4!"($59'>$/+2!,:!3#/1#$'(,2$
/9:#)#.$2+5-&-,$4&#/+9$!&#)$/,:#)#.$4&)-42,9$4&#/#>$)$:5?&91@$/9/!3)2$,/?<$2+5-&-,$4&#/+9$/$3!,5B42-$3!$3#+91@$23-+59%2:(<=191@$/;#01212-"#$"(6$/;#3#<=1-C!$+2-&(1@!'!012=$!6<B5=$/+2!,:2-'7
2.
!342,$!3&B1)+9>$4!342,$-"-:5&!+21)+9>$!$:5?&9'$'!/#$/$#&57$F$4:5$G$(,5#/9$)$3+2#$GH$/&)-0+2#$IJJG$&7$!$4!342,2-$-"-:5&!+21)+9'>$6-)42-1)+9$4!342,$-"-:5&!+21)+9>$!$:5?&9'$'!/#$/$#&57$F$4:5$I$(,5#/9$)$3+2#$
GH$/&)-0+2#$IJJG$&7$!$4!342,2-$-"-:5&!+21)+9'>$4!342,$4!5/2-&3)!+9$4&!%2"-'$)#(%#+9'$- KL >$!$:5?&9'$'!/#$/$#&57$F$4:5$GM$(,5#/9$)$3+2#$GN$"(5-C!$IJJM$&7$!$2+%!&'#59)#1<2$3)2#;#"+!012$4!3'2!5?/$&-#"2)(<=191@$
)#3#+2#$4(6"21)+->$"(6$/$4&)94#3:($,:;#3#+2#$/+2!,:($)#$4!'!1=$,9,5-'($5-"-2+%!&'#591)+-C!>$!$:5?&9'$'!/#$/$4&)-42,#1@$/93#+91@$+#$4!3,5#/2-$#&57$OJ$(,57$H$(,5#/9$P$ &#/!$C-!3-)9<+-$2$:#&5!C&#%21)+->$
23-+59%2:#5!&$('!*"2/2#<=19$/-&9%2:#1<B$/+2!,:!3#/19$/$59'$,9,5-'2-7
K968F.-'.-8A
1. D!&'("#&)-$3&(:!/#+-$+2-$'(,)=$(/)C"B3+2#.$!)+#1)-E$:!"!&9,591)+91@7
2.
!"#$%!&'("#&)#$'!*+#$&!),)-&)#.$/$)#"-*+!012$!3$4!5&)-67$8$4&)94#3:($/94-;+2#+2#$%!&'("#&)#$/$4!,5#12$4#42-&!/-<$%!&'("#&)$'!*-$69.$()(4-;+2#+9$)#;=1)+2:#'2$)#/2-&#<=19'2$2+%!&'#1<->$:5?&91@$+2-$'!*+#$69;!$
)#'2-012.$/$%!&'("#&)(7$$$
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' 5647 ',-1'.&8- (90.2), - :017./), ;0: 5647 %6$61.-&%'8
P3
Mapa:
',-1'.&8- (90.2), - :017./),
Skala:
zasadnicza
1:500
1:1000
1:2000
1:5000
wektorowa
TIFF
GeoTIFF
inny: .....................
rastrowa w formacie:
drukowana, w formacie:
A4
A3
A2
A1
A0
kolorowa
&%69.+<:-6*6
! '(%'54;69% /6=1'(+ 69/0$%6 5647
>> '(%'54;69%'?7 /6=1'(+ 69/0$%6 5647
,4-#.04:'):!"#$%&'%&#(
)*+),#%')&-'%.!/&01"23')4567#8)45"9.!):%&460&';)
8'1.+$2/- 4+1%-6*0 2'972+9-6;.'(+
8'1.+$2/- 4+1%-6*0 /9680 $2+$+,6.' , DE-F
G8'1.+$2/- ',-1"H +:93:7 ',-1"H 1%-6*/- ',-1"I
,7/6% (+1'* 69/0$%7 5647
+:$%69 +/9'A;+.7 .6 %6*B&%.-/0 (96K-&%.75
@:$%69 +/9'A;+.7 , %6*B&%+.75 4;-/0 ,'/2+9+,75 , 0/*61%-' ,$4)*"C
PL-2000
-..75 1+40$%&%+.75 49%'% +9(6. 49+,61%B&7 %6$): >>"">"
J$4)*9%31.' 4+;-(+.0 , 0/*61%-' ,$4)*"C
PL-2000
-..75 1+40$%&%+.75 49%'% +9(6. 49+,61%B&7 %6$): >>>>"
)<+),4-#.04:'):!"#$%&'%&#)&)1:#=&):%&4604-#:3!
WNIOSKODAWCA
1
L5-3H .6%,-$/+ +96% 4+14-$ ,.-+$/+16,&7
Przypisy:
1.
!"#$%&!"'()*+,-&#!"#$%&./.01'!+$)*+,-&!&012',3&3!45&4&5'16&7&#01&8&9%154,&*&"+$5&8:&4'*.;+$5&<==8&'6&!&#!"#$%$.&./.01'!+$)*+,3-&>.*#$.)*+,&#!"#$%&./.01'!+$)*+,-&!&012',3&3!45&4&5'16&7&#01&<&9%154,&*&"+$5&
8:&4'*.;+$5&<==8&'6&!&#!"#$%$.&./.01'!+$)*+,3-&#!"#$%&#!14$.'"*!+,&#'!?$/.3&*59?5+,3&. @A -&!&012',3&3!45&4&5'16&7&#01&8B&9%154,&*&"+$5&8C&/91.D!&<==B&'6&!&$+?!'351,*5)E$&"*$5F5/+!;)$&#!"3$!124&'.5/$*9EG),)H&
*5"5+$5&#9>/$)*+.-&/9>&4&#'*,#5"09&%0F5"5+$5&4+$!%09&*5&#!3!)G&%,%1.39&1./.$+?!'351,)*+.D!-&!&012',3&3!45&4&#'*.#$%5)H&4,"5+,)H&+5&#!"%154$.&5'16&I=&9%16&:&9%154,&J& '54!&D.!".*,E+.&$&05'1!D'5?$)*+.-&
$".+1,?$051!'&93!K/$4$5EG),&4.',?$05)E(&4+$!%0!"54),&4&1,3&%,%1.3$.6
!"#$%&'%&#(
1. L!'39/5'*.&"'90!45+.&+$.&39%*G&94*D/("+$5M&!*+5)*.N&0!/!',%1,)*+,)H6
2.
!"#$%!&'("#&)#$'!*+#$&!),)-&)#.$/$)#"-*+!012$!3$4!5&)-67$8$4&)94#3:($/94-;+2#+2#$%!&'("#&)#$/$4!,5#12$4#42-&!/-<$%!&'("#&)$'!*-$69.$()(4-;+2#+9$)#;=1)+2:#'2$)#/2-&#<=19'2$2+%!&'#1<->$:5?&91@$+2-$'!*+#$69;!$
)#'2-012.$/$%!&'("#&)(7$$$
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' 5'6'$250 &'. - ,752+8&- .-'50&9+:+8&-
P4
UA-)5 17.=&9 1+2=&%D&=&9 &'. 257.$7/&=6.=&9
.-'50&9+:+8&- , 4+$27&- 'C'/25+.-&%.'6
UA-)5 17.=&9 1+2=&%D&=&9 ,752+8&- .-'50&9+:+8&w postaci elektronicznej
M=&-D( % @S-MP , 4+$27&- 1+/0:'.20 150/+,7.'(+
%7,-'576D&= &'.= 257.$7/&=6.'
M=&-D( % @S-MP , 4+$27&- 1+/0:'.20 150/+,7.'(+
%7,-'576D&= ,752+8&- .-'50&9+:+8&-
;/5'$< , /2)5=: %+$27*= %7,752' 257.$7/&6'
067,.-+.' , 5'6'$25%'> +1 ??????""" 1+ ????""??"
@+1%76' .-'50&9+:+8&->
.-'%7A01+,7.7 6'1.+0B=2/+,7 5+C.7
.-'%7A01+,7.7 5+C.7 ,-'C+0B=2/+,7
.-'%7A01+,7.7 C'8.7
zabudowana rolna
.-'%7A01+,7.7 45%'%.7&%+.7 4+1 %7A01+,3 -..D .-B %7(5+1+,7
zabudowana budynkiem lub budynkami mieszkalnymi
%7A01+,7.7 A01=./7:- 4'*.-D&=:- -..' E0./&6'
budynkowa
lokalowa
%7A01+,7.7 C'8.7
-..7 .-'50&9+:+8F
G+172/+,' /5=2'5-7 ,=A+50 .-'50&9+:+8&-1:
G+172/+,' ,=678.-'.-7>
T" G7.' -1'.2=E-/06D&' +A$%75 +A632= ,.-+$/-':
6'1.+$2/- 4+1%-7*0 2'5=2+5-7C.'(+
6'1.+$2/- 4+1%-7*0 /5760 $2+$+,7.' , HI-J
K6'1.+$2/- ',-1"< +A53A= ',-1"< 1%-7*/- ',-1"L
+A$%75 +/5'8C+.= .7 %7*D&%.-/0 (57E-&%.=:
;A$%75 +/5'8C+.= , %7*D&%+.=: 4C-/0 ,'/2+5+,=: , 0/*71%-' ,$4)*">
PL-2000
-..=: 1+40$%&%+.=: 45%'% +5(7. 45+,71%D&= %7$)A ??""?"
M$4)*5%31.' 4+C-(+.0 , 0/*71%-' ,$4)*">
PL-2000
-..=: 1+40$%&%+.=: 45%'% +5(7. 45+,71%D&= %7$)A ????"
2
O" P5 0457,.-'Q %7,+1+,=&9 5%'&%+%.7,&= :76D2/+,'(+
R" G+172/+,' ,=678.-'.-7 - 0,7(- ,.-+$/+17,&=
WNIOSKODAWCA
3
N:-3< .7%,-$/+ +57% 4+14-$ ,.-+$/+17,&=
Przypisy:
1. 8$4!"($'!*+#$/,:#)#.$3!3#5:!/-$:&95-&2#>$5#:2-$<#:A$4&)-)+#1)-+2-$/$'2-<,1!/9'$4"#+2-$)#B!,4!3#&!/#+2#$4&)-,5&)-++-B!>$&!3)#<$5&#+,#:1<2>$&!3)#<$&9+:($C/$!3+2-,2-+2($3!$+2-&(1@!'!012$"!:#"!/91@D>$+&$
:!+39B+#1<2$C/$!3+2-,2-+2($3!$+2-&(1@!'!012$"!:#"!/91@D>$B;?/+#$%(+:1<#$6(39+:(>$&!3)#<$"!:#"(>$4!/2-&)1@+2#$+2-&(1@!'!012$!3$77777$3!$777777>$4!/2-&)1@+2#$(*95:!/#$6(39+:($!3$777777$3!$777777>$4!/2-&)1@+2#$(*95:!/#$
lokalu od ..... do .........
2. E+%!&'#1<#$/9'#B#+#>$<-*-"2$(3!,5F4+2#+-$3#+-$GH28I$/9:!&)9,59/#+-$6F3=$3!$/9:!+#+2#$/91-+9$+2-&(1@!'!0127$
3.
!342,$!3&F1)+9>$4!342,$-"-:5&!+21)+9>$!$:5?&9'$'!/#$/$#&57$J$4:5$K$(,5#/9$)$3+2#$KL$/&)-0+2#$MNNK$&7$!$4!342,2-$-"-:5&!+21)+9'>$6-)42-1)+9$4!342,$-"-:5&!+21)+9>$!$:5?&9'$'!/#$/$#&57$J$4:5$M$(,5#/9$)$3+2#$
KL$/&)-0+2#$MNNK$&7$!$4!342,2-$-"-:5&!+21)+9'>$4!342,$4!5/2-&3)!+9$4&!%2"-'$)#(%#+9'$- OP >$!$:5?&9'$'!/#$/$#&57$J$4:5$KQ$(,5#/9$)$3+2#$KR$"(5-B!$MNNQ$&7$!$2+%!&'#59)#1<2$3)2#;#"+!012$4!3'2!5?/$&-#"2)(<=191@$
)#3#+2#$4(6"21)+->$"(6$/$4&)94#3:($,:;#3#+2#$/+2!,:($)#$4!'!1=$,9,5-'($5-"-2+%!&'#591)+-B!>$!$:5?&9'$'!/#$/$4&)-42,#1@$/93#+91@$+#$4!3,5#/2-$#&57$SN$(,57$L$(,5#/9$T$ &#/!$B-!3-)9<+-$2$:#&5!B&#%21)+->$
23-+59%2:#5!&$('!*"2/2#<=19$/-&9%2:#1<F$/+2!,:!3#/19$/$59'$,9,5-'2-7
M=678.-'.-7>
1. U!&'("#&)-$3&(:!/#+-$+2-$'(,)=$(/)B"F3+2#.$!)+#1)-V$:!"!&9,591)+91@7
2.
!"#$%!&'("#&)#$'!*+#$&!),)-&)#.$/$)#"-*+!012$!3$4!5&)-67$8$4&)94#3:($/94-;+2#+2#$%!&'("#&)#$/$4!,5#12$4#42-&!/-<$%!&'("#&)$'!*-$69.$()(4-;+2#+9$)#;=1)+2:#'2$)#/2-&#<=19'2$2+%!&'#1<->$:5?&91@$+2-$'!*+#$69;!$
)#'2-012.$/$%!&'("#&)(7$$$
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' %5-+6), 17.8&9 :;<#=
P5
>'*.8 %5-)6 17.8&9
?8567.8 %5-)6 17.8&9 :;<#= @/A7$7 +5-'/2),BC
46%',)1 5'.%8.+,8
46%',)1 &-'4*+,.-&%8
46%',)1 'A'/26+'.'6('28&%.8
przewód gazowy
przewód kanalizacyjny
przewód naftowy
przewód telekomunikacyjny
/!"%,8$(,1$1*'#91,5
przewód niezidentyfikowany
przewód inny
obudowa przewodu
budowla podziemna
!"#$"%&'%()%*+&'*"&%(",'#"-&%("(.'%*'#
/ &0)(1(10!%231&%4(,5.1012*'
.6 /('(7-.")
01!5)-!"(/!"%.561,5
Dodatkowe informacje:
)6+),#%')&.'%/!7&02"85')-94:#;)-9"</!)1%&-40&'=)
H'1.+$2/- 4+1%-7*0 2'682+6-7A.'(+
H'1.+$2/- 4+1%-7*0 /67H0 $2+$+,7.' , ;:-I
@H'1.+$2/- ',-1"K +56358 ',-1"K 1%-7*/- ',-1"B
,8/7% (+1'* 76/0$%8 G748
+5$%76 +/6'EA+.8 .7 %7*F&%.-/0 (67L-&%.8G
D5$%76 +/6'EA+.8 , %7*F&%+.8G 4A-/0 ,'/2+6+,8G , 0/*71%-' ,$4)*"C
PL-2000
-..8G 1+40$%&%+.8G 46%'% +6(7. 46+,71%F&8 %7$)5 JJ""J"
?$4)*6%31.' 4+A-(+.0 , 0/*71%-' ,$4)*"C
PL-2000
-..8G 1+40$%&%+.8G 46%'% +6(7. 46+,71%F&8 %7$)5 JJJJ"
)*+),-.#/0-1')1!"#$%&'%&#)&)21#3&)1%&-40-.#15!
WNIOSKODAWCA
MG-3K .7%,-$/+ +67% 4+14-$ ,.-+$/+17,&81
Przypisy:
1.
!"#$%&!"'()*+,-&#!"#$%&./.01'!+$)*+,-&!&012',3&3!45&4&5'16&7&#01&8&9%154,&*&"+$5&8:&4'*.;+$5&<==8&'6&!&#!"#$%$.&./.01'!+$)*+,3-&>.*#$.)*+,&#!"#$%&./.01'!+$)*+,-&!&012',3&3!45&4&5'16&7&#01&<&9%154,&*&"+$5&
8:&4'*.;+$5&<==8&'6&!&#!"#$%$.&./.01'!+$)*+,3-&#!"#$%&#!14$.'"*!+,&#'!?$/.3&*59?5+,3&. @A -&!&012',3&3!45&4&5'16&7&#01&8B&9%154,&*&"+$5&8C&/91.D!&<==B&'6&!&$+?!'351,*5)E$&"*$5F5/+!;)$&#!"3$!124&'.5/$*9EG),)H&
*5"5+$5&#9>/$)*+.-&/9>&4&#'*,#5"09&%0F5"5+$5&4+$!%09&*5&#!3!)G&%,%1.39&1./.$+?!'351,)*+.D!-&!&012',3&3!45&4&#'*.#$%5)H&4,"5+,)H&+5&#!"%154$.&5'16&I=&9%16&:&9%154,&J& '54!&D.!".*,E+.&$&05'1!D'5?$)*+.-&
$".+1,?$051!'&93!K/$4$5EG),&4.',?$05)E(&4+$!%0!"54),&4&1,3&%,%1.3$.6
!"#$%&'%&#(
1. L!'39/5'*.&"'90!45+.&+$.&39%*G&94*D/("+$5M&!*+5)*.N&0!/!',%1,)*+,)H6
2.
!"#$%!&'("#&)#$'!*+#$&!),)-&)#.$/$)#"-*+!012$!3$4!5&)-67$8$4&)94#3:($/94-;+2#+2#$%!&'("#&)#$/$4!,5#12$4#42-&!/-<$%!&'("#&)$'!*-$69.$()(4-;+2#+9$)#;=1)+2:#'2$)#/2-&#<=19'2$2+%!&'#1<->$:5?&91@$+2-$'!*+#$69;!$
)#'2-012.$/$%!&'("#&)(7$$$
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' %5-+6), 17.8&9 :;<=>
P6
?'*.8 %5-)6 17.8&9
@5-)6 17.8&9 5'% +5$'6,7&AB8/7% ,$4)*6%31.8&9 - ,8$+/+C&- 40./2),
Opisy topograficzne
D747 E05 $%/-& 46%'(EF1+,8
Rodzaj osnowy:
pozioma
!"#$%&$'()*()'(#+
PL-ETRF89
PL-ETRF2000
,8$+/+C&-+,7
!"#$%,2*&!&53(&,2+
PL-KRON86-NH
PL-EVRF2007-NH
G..8H IIII"
!"#$%,*-."/01$'234+
XYZ
GRS80h
GRS80H
PL-1992
PL-2000
1965.
;+172/+,' ,8A7C.-'.-7H
M" ;7.' -1'.28K-/0AF&' +5$%76 +5A328 ,.-+$/-'J E05 40./28 +$.+,8 ('+1'%8A.'A
A'1.+$2/- 4+1%-7*0 2'682+6-7E.'(+
,8/7% (+1'* 76/0$%8 J74
,8/7% -1'.28K-/72+6), 40./2), +$.+,8 ('+1'%8A.'A
+5$%76 +/6'CE+.8 .7 %7*F&%.-/0 (67K-&%.8J
=5$%76 +/6'CE+.8 , %7*F&%+.8J 4E-/0 ,'/2+6+,8J , 0/*71%-' ,$4)*"H
PL-2000
-..8J 1+40$%&%+.8J 46%'% +6(7. 46+,71%F&8 %7$)5 II""I"
B$4)*6%31.' 4+E-(+.0 , 0/*71%-' ,$4)*"H
PL-2000
-..8J 1+40$%&%+.8J 46%'% +6(7. 46+,71%F&8 %7$)5 IIII"
N" ;+172/+,' ,8A7C.-'.-7 - 0,7(- ,.-+$/+17,&8
WNIOSKODAWCA
GJ-3L .7%,-$/+ +67% 4+14-$ ,.-+$/+17,&81
Przypisy:
1. :!*>./)!*"24'-6C)>!*>./)(%(+7"!-.4'-6C)!)+7D"6#)#!,&),)&"79)E)>+7)F)$/7&,6)')*-.&)FG),"'(=-.&)HIIF)"9)!)>!*>./.()(%(+7"!-.4'-6#C)?('>.(4'-6)>!*>./)(%(+7"!-.4'-6C)!)+7D"6#)#!,&),)&"79)E)>+7)H)$/7&,6)')*-.&)
FG),"'(=-.&)HIIF)"9)!)>!*>./.()(%(+7"!-.4'-6#C)>!*>./)>!7,.("*'!-6)>"!;.%(#)'&$;&-6#)(:JK:C)!)+7D"6#)#!,&),)&"79)E)>+7)FL)$/7&,6)')*-.&)FM)%$7(1!)HIIL)"9)!).-;!"#&76'&4B.)*'.&A&%-!=4.)>!*#.!7D,)"(&%.'$B04648)
'&*&-.&)>$?%.4'-(C)%$?),)>"'6>&*+$)/+A&*&-.&),-.!/+$)'&)>!#!40)/6/7(#$)7(%(.-;!"#&764'-(1!C)!)+7D"6#)#!,&),)>"'(>./&48),6*&-648)-&)>!*/7&,.()&"79)NI)$/79)G)$/7&,6)O):"&,!)1(!*('6B-().)+&"7!1"&;.4'-(C)
.*(-76;.+&7!")$#!<%.,.&B046),("6;.+&4B2),-.!/+!*&,46),)76#)/6/7(#.(9
B8A7C.-'.-7H
1.
!"#$%&"'()*"$+!,&-()-.()#$/'0)$,'1%2*-.&3)!'-&4'(5)+!%!"6/764'-6489
2. :!%&);!"#$%&"'&)#!<-&)"!'/'("'&3),)'&%(<-!=4.)!*)>!7"'(?9)@)>"'6>&*+$),6>(A-.&-.&);!"#$%&"'&),)>!/7&4.)>&>.("!,(B);!"#$%&"')#!<()?63)$'$>(A-.&-6)'&A04'-.+&#.)'&,.("&B046#.).-;!"#&4B(C)+7D"648)-.()#!<-&)?6A!)
'&#.(=4.3),);!"#$%&"'$9)))
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' %5-+6), 17.8&9 57%8 17.8&9 :;<=>??
P7
@'*.8 %5-)6 17.8&9
A8567.8 %5-)6 17.8&9 :;<=>?? B/72'(+6-7 /C7$ +5-'/2),DE
501+,C' - 06%F1%'.-7
komunikacja i transport
pokrycie terenu
obiekty inne
!"#$%&'" "()
Dodatkowe informacje:
)*+),-.'/0-.'%%#)123#1&.#4"#)25/.#-6)25"70'82)9%&2/3&':)
G'1.+$2/- 4+1%-7*0 2'682+6-7C.'(+
,8/7% (+1'* 76/0$%8 I748
+5$%76 +/6'HC+.8 .7 %7*F&%.-/0 (67K-&%.8I
<5$%76 +/6'HC+.8 , %7*F&%+.8I 4C-/0 ,'/2+6+,8I , 0/*71%-' ,$4)*"E
PL-2000
-..8I 1+40$%&%+.8I 46%'% +6(7. 46+,71%F&8 %7$)5 JJ""J"
A$4)*6%31.' 4+C-(+.0 , 0/*71%-' ,$4)*"E
PL-2000
-..8I 1+40$%&%+.8I 46%'% +6(7. 46+,71%F&8 %7$)5 JJJJ"
);+)<2=#0329')9!"#$%&'%&#)&)69#8&)9%&2/32=#94!
WNIOSKODAWCA
LI-3M .7%,-$/+ +67% 4+14-$ ,.-+$/+17,&81
Przypisy:
1. 0+12#3(+1,4& 567(2+12#3($.$89,+5#& 567(+(89:,6"("+)!()(!,9/(;(289(<(-39!)6( (15#!(<=(), $%5#!(>??<(,/(+(2+12#3#$($.$89,+5#& 56"7(@$ 2#$& 56(2+12#3($.$89,+5#& 567(+(89:,6"("+)!()(!,9/(;(289(>(-39!)6( (15#!(
<=(), $%5#!(>??<(,/(+(2+12#3#$($.$89,+5#& 56"7(2+12#3(2+9)#$,1 +56(2,+*#.$"( !-*!56"($0AB07(+(89:,6"("+)!()(!,9/(;(289(<C(-39!)6( (15#!(<D(.-9$E+(>??C(,/(+(#5*+,"!96 !&F#(1 #!G!.5+%&#(2+1"#+9:)(,$!.# -FH&6&I(
!1!5#!(2-@.#& 5$7(.-@()(2, 62!18-(38G!1!5#!()5#+38-( !(2+"+&H(3639$"-(9$.$#5*+,"!96& 5$E+7(+(89:,6"("+)!()(2, $2#3!&I()61!56&I(5!(2+139!)#$(!,9/(J?(-39/(=(-39!)6(K(0,!)+(E$+1$ 6F5$(#(8!,9+E,!*#& 5$7(
#1$596*#8!9+,(-"+L.#)#!FH&6()$,6*#8!&F4()5#+38+1!)&6()(96"(3639$"#$/
!"#$%&'%&#(
1. M+,"-.!, $(1,-8+)!5$(5#$("-3 H(-) E.415#!'(+ 5!& $N(8+.+,6396& 56&I/
2.
!"#$%!&'("#&)#$'!*+#$&!),)-&)#.$/$)#"-*+!012$!3$4!5&)-67$8$4&)94#3:($/94-;+2#+2#$%!&'("#&)#$/$4!,5#12$4#42-&!/-<$%!&'("#&)$'!*-$69.$()(4-;+2#+9$)#;=1)+2:#'2$)#/2-&#<=19'2$2+%!&'#1<->$:5?&91@$+2-$'!*+#$69;!$
!"#$%&#'()(*+,"-.!, -/(((
Formularz
!" #$%&%'()*+,-'.-' ,.-+$/0 + 01+$234.-'.-' -..5&6 782'9-8*),
P8
Drukowana mapa topograficzna w skali:
1:10 000
1:25 000
;90/+,8.8 7848 +()<.+('+(98=-&%.8 , $/8<-:
@..' 7845 $5208&5A.' <0? $5208&5A.+ ,5$+/+B&-+,'
Ortofortomapa
Kompozycja barwna:
RGB / BW
RGB + CIR
D/208<.+BE +92+=+2+7845:
ostatnio wykonana
wykonana w latach:
1:50 000
1:100 000
1:250 000
1:500 000
1:1 000 000
ploterowy wydruk kolorowy
4<+2'9+,5 ,5190/ &%89.+>?-8*5
druk poligraficzny
#/*81 ,$4)*9%31.5&6:
PL-1942
1965.
PL-1992
PL-2000
;+/07'.25 ,&6+1%C&' , $/*81 +4'982), 2'&6.-&%.5&6
@..' 782'9-8*5
;+182/+,' ,5A8B.-'.-8:
P" ;8.' -1'.25=-/0AC&' +?$%89 +?A325 ,.-+$/-'7
A'1.+$2/- 4+1%-8*0 2'952+9-8<.'(+
A'1.+$2/- 4+1%-8*0 /98A0 $2+$+,8.' , GH-I
JA'1.+$2/- ',-1"K +?93?5 ',-1"K 1%-8*/- ',-1"L
-1'.25=-/82+95 +4'982), 2'&6.-&%.5&6
+?$%89 +/9'B<+.5 .8 %8*C&%.-/0 (98=-&%.57
F?$%89 +/9'B<+.5 , %8*C&%+.57 4<-/0 ,'/2+9+,57 , 0/*81%-' ,$4)*":
PL-2000
-..57 1+40$%&%+.57 49%'% +9(8. 49+,81%C&5 %8$)? MM""M"
N$4)*9%31.' 4+<-(+.0 , 0/*81%-' ,$4)*":
PL-2000
-..57 1+40$%&%+.57 49%'% +9(8. 49+,81%C&5 %8$)? MMMM"
O" ;+182/+,' ,5A8B.-'.-8 - 0,8(- ,.-+$/+18,&5
WNIOSKODAWCA
1
@7-3K .8%,-$/+ +98% 4+14-$ ,.-+$/+18,&5
Przypisy:
1. :!*>./)!*"24'-6C)>!*>./)(%(+7"!-.4'-6C)!)+7D"6#)#!,&),)&"79)E)>+7)F)$/7&,6)')*-.&)FG),"'(=-.&)HIIF)"9)!)>!*>./.()(%(+7"!-.4'-6#C)?('>.(4'-6)>!*>./)(%(+7"!-.4'-6C)!)+7D"6#)#!,&),)&"79)E)>+7)H)$/7&,6)')*-.&)
FG),"'(=-.&)HIIF)"9)!)>!*>./.()(%(+7"!-.4'-6#C)>!*>./)>!7,.("*'!-6)>"!;.%(#)'&$;&-6#)(:JK:C)!)+7D"6#)#!,&),)&"79)E)>+7)FL)$/7&,6)')*-.&)FM)%$7(1!)HIIL)"9)!).-;!"#&76'&4B.)*'.&A&%-!=4.)>!*#.!7D,)"(&%.'$B04648)
'&*&-.&)>$?%.4'-(C)%$?),)>"'6>&*+$)/+A&*&-.&),-.!/+$)'&)>!#!40)/6/7(#$)7(%(.-;!"#&764'-(1!C)!)+7D"6#)#!,&),)>"'(>./&48),6*&-648)-&)>!*/7&,.()&"79)NI)$/79)G)$/7&,6)O):"&,!)1(!*('6B-().)+&"7!1"&;.4'-(C)
.*(-76;.+&7!")$#!<%.,.&B046),("6;.+&4B2),-.!/+!*&,46),)76#)/6/7(#.(9
N5A8B.-'.-8:
1.
!"#$%&"'()*"$+!,&-()-.()#$/'0)$,'1%2*-.&3)!'-&4'(5)+!%!"6/764'-6489
2. :!%&);!"#$%&"'&)#!<-&)"!'/'("'&3),)'&%(<-!=4.)!*)>!7"'(?9)@)>"'6>&*+$),6>(A-.&-.&);!"#$%&"'&),)>!/7&4.)>&>.("!,(B);!"#$%&"')#!<()?63)$'$>(A-.&-6)'&A04'-.+&#.)'&,.("&B046#.).-;!"#&4B(C)+7D"648)-.()#!<-&)?6A!)
'&#.(=4.3),);!"#$%&"'$9)))