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[null,null,null,null,null,"İL MÜDÜRÜ ÜNVANINI YAZINIZ"]
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[null,null,"T. C. GIDA TARIM VE"]
[null,null,"HAYVANCILIK BAKANLIĞI"]
[null,null,"…………………………………….",null,"İl Müdürlüğü"]
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[null,null,"GÜBRE DAĞITICILIK BELGESİ"]
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[null,null,"Belge Numarası:",":…………………………………………………………………………………………………………………………"]
[null,null,"Düzenleme Tarihi:",":…………………………………………………………………………………………………………………………"]
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[null,null,"Dağıtıcının:"]
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[null,null,"Adı, Soyadı veya Ticari Unvanı:",null,":……………………………………………………………………………………………………………."]
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[null,null,"T. C. Kimlik No - Vergi Kimlik No:",null,":……………………………………………………………………………………………………………."]
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[null,null,"Mersis Numarası (Varsa):",null,":……………………………………………………………………………………………………………."]
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[null,null,"İşyeri Adresi:",null,":……………………………………………………………………………………………………………."]
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[null,null,"Depo Adresi:",null,":……………………………………………………………………………………………………………."]
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[null,null,"Yukarıda bilgileri yer alan ","…………...(Adı, Soyadı veya Ticari Unvanı)………………………………………………………"]
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[null,null,"29/3/2014 tarihli ve 28956 sayılı Resmî Gazete' de yayımlanan Gübrelerin Piyasa Gözetimi ve Denetimi "]
[null,null,"Yönetmeliği hükümlerine göre yetkilendirilmiştir."]
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[null,null,null,null,null,"İl Müdürü"]
[null,null,null,null,null,"Mühür ve İmza"]