Naziv zdravstvene ustanove

. . . "} ;l \'
,-~•v• ·'
f~
t,/11
J'r,, -~
,.
...t :-. \ ~(;~--~ J. ~· "' POTVRDA
jli;j'll'ilil l,tlli>:,.ll.
1-t;.O q\\ll
. /-tr87'o' ·., .
5T~FIJ;I/
(pret ime, ocevo ime i ime) ··············································································································
, '1
ucenik-ca ......................................................... razreda skole............................. f;;i-1.J. . . . . . . .y .....-:J. ... . . . Jr-/':J/l,t 't . . . . . JI.- ~it!)
izostaJo-Ia je od pohada~ja nastave od..................... /..f... :..QC:...........................................................do ...........l..</... . .e[:. ................. . . . . . . . .. . . . . . .. . 2021 .......... godine
usled oboljenja od ............................................................................................................................................................................................................................................................................................................................. ..
.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . ·:..
. -.. ... .. . . . . . . . . . .... £¥0 . r ................ .................... .
Ova potvrda se izdaje radi pravdanja izostanak~. t~ ,,7.
. /· . . _ , -f 'c<.:. / ~
Ucem'ka-cu t re b a os1ob od'ti
V
I nas t ave tiIZI·ckog v 11t anJa
· r asp1 ···· ..... ,..:':::~".'u
-' ~: ...... a: •• c.\.t .,~ ................................................................................................. d ana, od nosno do
,. , . ( /i • .'. -::·~ : •, •' ·..:,.::: --77 -
dana.......................................~•······................. 20................... godme. ( ~. ·; , \;..:._:. , , - :- lti'.l M~J!HU,fffe
Broj amb. dnev: .............................................................................................. f,o (,.,. -. ,. .._
•''I,:).
·<~ ----
(Mm · '); ·.· .
I' c Q, ·.•c1
:.1 !',.._
C . 3 Mpq1>n1r,.h,
. ~ 1"111.··
.. , Ir " ,. ,
'. Q _..,-,.· u Uv0 1934Q
. .. . . . . . . .. ... . . . ..(f ~
D 0. . . . . . . . . . . . .. . .... . . . . . . . 20 .....23. . ~ - ,;;;:;;;;:.• ..?"' ········--::::::::::""'· - u c ~··•·····•·····...........................
r
Grafo-centar doo Futog
Oznaka za porudzbinu: Obr. br. 4/130