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{"sheet":"Strona 1","index":0,"n_rows":85,"n_cols":18,"rows_kept":85,"cut":false,"hidden":false,"merged":[[81,4,81,7],[82,4,82,7],[83,4,83,7],[84,4,84,7],[77,4,77,7],[78,4,78,7],[79,4,79,7],[80,4,80,7],[73,4,73,7],[74,4,74,7],[75,4,75,7],[76,4,76,7],[69,4,69,7],[70,4,70,7],[71,4,71,7],[72,4,72,7],[29,2,29,6],[15,6,15,8],[8,1,8,4],[18,4,18,17],[13,1,14,3],[22,1,22,17],[53,2,53,11],[53,12,53,17],[15,11,15,14],[14,5,14,8],[48,1,48,17],[50,1,50,17],[51,1,51,17],[52,2,52,17],[39,15,39,17],[45,2,45,17],[46,2,46,17],[47,1,47,17],[44,1,44,17],[41,11,41,17],[42,11,42,17],[42,2,42,6],[43,1,43,17],[41,2,41,6],[40,15,40,17],[26,2,26,17],[34,1,34,17],[35,2,35,17],[31,1,31,17],[27,2,27,17],[28,2,28,17],[36,2,36,17],[39,2,39,10],[40,2,40,10],[5,9,5,13],[6,9,8,13],[14,11,14,14],[20,2,20,17],[17,4,17,17],[13,9,13,14],[6,15,6,17],[7,15,8,17],[4,1,7,8],[66,1,66,14],[66,15,66,16],[59,12,59,16],[60,12,60,17],[59,3,59,9],[62,7,62,17],[63,7,63,17],[62,2,62,6],[63,2,63,6],[58,2,58,9],[39,11,39,14],[40,11,40,14],[41,7,41,10],[42,7,42,10],[58,12,58,17],[54,12,54,17],[55,2,55,4],[55,5,55,9],[55,11,55,16],[38,2,38,9],[38,10,38,17],[33,1,33,17],[18,1,18,3],[19,4,19,17],[30,1,30,17],[23,1,23,17],[25,1,25,17],[21,2,21,17],[29,7,29,17],[1,1,1,17],[56,2,57,17],[64,1,64,17],[4,12,4,13],[37,2,37,9],[37,10,37,17],[9,1,11,17],[17,1,17,3],[2,1,3,17],[5,15,5,17]],"flags":["formulas_cached_only"]}
[]
[null,"WYPEŁNIA URZĄD SKARBOWY"]
[null,"Nazwa i adres organu podatkowego [Name and address of tax authority]"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,"Miejscowość\n[Locality]"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Data (dzień - miesiąc - rok)\n[Date (day - month - year)]"]
[null,"CFR-1"]
[null,"ZAŚWIADCZENIE O MIEJSCU ZAMIESZKANIA LUB SIEDZIBIE\nDLA CELÓW PODATKOWYCH (CERTYFIKAT REZYDENCJI)\n[CERTIFICATE OF TAX RESIDENCE]"]
[]
[]
[]
[null,"ZA OKRES\n[FOR PERIOD]",null,null," 1. Od [From] (dzień–miesiąc–rok) [(day - month - year)]",null,null,null,null," 2. Do [To] (dzień – miesiąc – rok) [(day - month - year)]1)"]
[]
[]
[]
[null," Podstawa prawna:",null,null,"Art.306l ustawy z dnia 29 sierpnia 1997 r. - Ordynacja podatkowa (Dz.U. z 2005 r. Nr 8, poz.60, z późn. zm.). "]
[null," [Legal basis:",null,null,"Art.306l of the Act of 29 August 1997 r. - Tax Liabilities' Code (Dz. U. 2005, No 8, item 60, with subsequent amendments)]"]
[]
[null,null," 3. Numer zaświadczenia [Certificate number]"]
[]
[null,"zaświadcza się niniejszym, że:"]
[null,"[hereby certifies that:]"]
[]
[null," A. DANE IDENTYFIKACYJNE [IDENTIFICATION]"]
[null,null," 4. Nazwa pełna, REGON / Nazwisko, pierwsze imię [Full Name, REGON / Family name, first name]"]
[]
[null,null," 5. Identyfikator podatkowy NIP / numer PESEL (niepotrzebne skreslić) [Tax Identification Number / Personal number PESEL (delete as apriopriate)]"]
[]
[null,"ma miejsce zamieszkania / siedzibę w Polsce"]
[null,"[is a resident in Poland]"]
[]
[null," B. MIEJSCE ZAMIESZKANIA LUB SIEDZIBA W POLSCE"]
[null,"[PLACE OF RESIDENCE IN POLAND]"]
[null,null," 6. Województwo [Province]"]
[]
[null,null," 7. Powiat [District]",null,null,null,null,null,null,null," 8. Gmina [Commune]"]
[]
[null,null," 9. Ulica [Street]",null,null,null,null,null,null,null,null," 10. Nr domu [Building number]",null,null,null," 11. Nr lokalu [Flat number]"]
[]
[null,null," 12. Miejscowość [Locality]",null,null,null,null," 13. Kod pocztowy [Postal code]",null,null,null," 14. Poczta [Post office]"]
[]
[null,"i podlega nieograniczonemu obowiązkowi podatkowemu w rozumieniu umowy między Rządem Rzeczypospolitej Polskiej a:"]
[null,"[and is subject to unlimited tax liability on his worldwide income within the meaning of agreement between the Government of the Republic of Poland and:]"]
[null,null," 15. Umawiające się Państwo [Contracting State]"]
[]
[null,"w sprawie unikania podwójnego opodatkowania i zapobiegania uchylaniu się od opodatkowania w zakresie podatków od dochodu."]
[null,"[for the avoidance of double taxation and the prevention of fiscal evasion with respect to taxes on income.]"]
[]
[null," C. ADNOTACJA DOTYCZĄCA OPŁATY SKARBOWEJ"]
[null,"[INFORMATION CONCERNING STAMP DUTY]"]
[null,null," 16. Opłata skarbowa (zaznaczyć właściwy kwadrat) [Stamp duty (tick right box)]"]
[null,null,"   1. dokonano zapłaty opłaty skarbowej [stamp duty paid]",null,null,null,null,null,null,null,null,null,"2. nie pobrano opłaty skarbowej [stamp duty unpaid]"]
[null,null,null,null,null,null,null,null,null,null,null,null,"podstawa prawna [legal basis]:"]
[null,null,"w wysokości [in the amount]",null,null,null,null,null,null,null,"zł"]
[null,null,"   3. zwolnienie lub wyłączenie od obowiązku zapłaty opłaty skarbowej [release or exemption from the obligation of payment of the stamp duty]"]
[]
[null,null,"podstawa prawna [legal basis]:"]
[]
[]
[]
[null,null," Pieczęć urzędowa [Tax authority seal]",null,null,null,null," Imię, nazwisko, stanowisko służbowe, podpis i pieczątka [First name, family name, position, signature and seal]"]
[]
[null,"1) Na wniosek podatnika, który na dzień wydania zaświadczenia posiada miejsce zamieszkania lub siedzibę dla celów podatkowych na terytorium\n    Polski, pozycji 2 nie wypełnia się.\n    [Upon taxpayer's request, whose place of residence lies within the territory of Poland on the day of issuing the certificate, column 2 shall not\n   be filled]"]
[]
[null,"© www.signform.pl Sp. z o.o., producent aktywnych formularzy, e-mail: biuro@signform.pl",null,null,null,null,null,null,null,null,null,null,null,null,null,"CFR-1(4)",null,"1/1"]
[]
[]
[null,null,null,null,"Dolnośląskie"]
[null,null,null,null,"Kujawsko-Pomorskie"]
[null,null,null,null,"Lubelskie"]
[null,null,null,null,"Lubuskie"]
[null,null,null,null,"Łódzkie"]
[null,null,null,null,"Małopolskie"]
[null,null,null,null,"Mazowieckie"]
[null,null,null,null,"Opolskie"]
[null,null,null,null,"Podkarpackie"]
[null,null,null,null,"Podlaskie"]
[null,null,null,null,"Pomorskie"]
[null,null,null,null,"Śląskie"]
[null,null,null,null,"Świętokrzyskie"]
[null,null,null,null,"Warmińsko-Mazurskie"]
[null,null,null,null,"Wielkopolskie"]
[null,null,null,null,"Zachodniopomorskie"]