KIYMETLİ EVRAK VE DEĞERLİ ŞEYLERİN ALINDI MAKBUZU

T.C.

……………………………..İcra Dairesi                                                              Örnek No : 16

Dosya No :………………………………

KIYMETLİ EVRAK VE DEĞERLİ ŞEYLERİN ALINDI MAKBUZU

Esas Kayıt No : …………………………………….                        Makbuz No : ……………………………

Teslim edenin adı, soyadı   ……………………………………………………………………..

Kıymetli evrak ve değerli şeylerin kaydına ilişkin kayıt numarası  : ……………………………….

Teslim  alınan  şeyin

                                                                                                Takdir edilen kıymeti

      Cinsi  ve  niteliği                            Miktarı                     Lira                           Kuruş 

…………………………………………                                        …………………          …………………………..

…………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          ………………………….. …………………………………………                                        …………………          …………………………..

            Yukarda cins ve miktarı yazılı …………………………………………………………………………..

kalem ayniyat alınmıştır.

                                                                                   ……./……/………

Teslim edenin adı,soyadı                                                         İcra Müdürü veya Yrd. 

                                                                                    Adı, soyadı

                                                                                                          Mühür ve İmza

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