PyKoBO.D.HTemo MEIIOY «lleTcKlill ca.u Mi 14»
(HaUMeHOBaHHe M)'HHUHila.JibHOro
.D.OIDKOJlbHOro o6pa.30BaTeJibHOro yqpe)l(,neHID!)
Pe)l(eBcKoro ropOllCKoro oKpyra (.n.anee - ynoJIHOMoqeHJlbIH opraH), KOTOpbIMH
npe.n.ocmsm1eTCS1 ycnyra

3AHBJIEHHE
o npei.ocTaBJieeee Myeuu,enaJILHoii yCJIYrH
«BLmJiaTa KOMneucau,ee qacTe pOJ!HTCJILCKoii oJiaTbl 1a npecMoTp e yxoi. 1a JlCTbMH
B rocyJ!apcToeeub1x e Mynuu,enaJibHblX 06pa1ooaTeJILHblX oprauu1au,eHx,
eaXOJ!HID.BXCH ea TeppeTopee cooTBCTCToy10mero cy6'beKTa PoccuiicKoii «lle)lepau,ee»
CoeMJIOBCKaH o6JiaCTL, PelKeBcKoii ropoJ!CKoii oKpyr
(YKa.3hJBaeTcsi cy6neKT PoccuiicKoii e.n.epauau: H MYHHUHTiaJihHOe o6pa.3oBaHHe)
Ilporny tta:3Ha'lltTb KOMneHCaJ..{HlO '13.CTH DJl3.Thl, 83HMaeMOH c po.n.HTeJieH (33.KOHHbIX npe,ll,CTaBHTeJieif) 33.
npHCMOTP H yxo.n. 33. pe6eHKOM, OCB3.HB8IOUIHM o6pa3083.TeJlbH)'JO nporpaMMY ,ll,OIDKOJibHOro o6pa3083.HIDI B
opraHU3allHH, OCYIIJ.eCTBJUIIOW.eH o6pa3oBaTeJibH)'JO .n.eneJibHOCTb (.n.anee - KOMnettcaQIDI):
M}'lnIUHIIaJibHOe 6IOJl)l(eTHOe .llOillKOJThHOe o6pa3oBaTeJThHOe me)l(,lleHHe «IleTCKHH ca,u N!! 14
«flacToqJ(a».
(HaHMeHOBaHHe o6p330BaTeJihHOH opraumaUHH)
Cse.n.eHIDI 06 OJJ.HOM H3 po.n.ureneii (3aKOHHblX npe.n.cTasHTeJieii) pe6eHI H yxo.n. 3a pe6eHKOM B COOTBeTCTBytOIL\eH
o6pa3oBaTeJlbHOH opraHH33.QHH (.n.anee - 3rulBHTeJib):
aMHJIIDl,HMjl,OTlfeCTBO(npHHaJIHlfHH): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

(.n.eHb, Mecsiu, ro.n.)
(M)')l(CKOH, )l(eHCKHH)

CTJ)axosoi1: HOMep HH.D.HBHJJ.YaJibttoro JIHQesoro C'ieTa: - - - - - - - - - - - - - - - - fpIDK,I.J,attcTso: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
,ZJ,attHI>Ie .n.oKyMeHTa, y.n.ocrosepmow.ero JIHl.JHOCTb:
Ha11MeH0Battue.n.0KyMeHTa,cepID1,HOMep: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
,[l,aTaBbl)J.a'IH:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
KeM BbI.D.aH, KO.D. no.n.paJ.n.erreHHjf: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
HoMep Terreotta (npu HaJIH'lltu):_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
A.n.pec 3JieKTJ)OHHOH DO'IThl (npu HaJIHl.JIDI): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
A.n.pec aKTu'lecKoro npmKHBaHHjf: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
CTaryc3rui:s11TerrH: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(po.n.ureJlb (ychrnosureJlb), orrexyH)

Cse.n.eHIDI o pe6ettKe, ocsaHBa10U1eM o6pa3oBaTeJibH)'JO nporpaMMY )J.OlllKOJibttoro o6pa30BaHl1jf B
opraHH3aQHH, ocyru:eCTBJIIDOU1eii o6pa3osaTeJibH)'JO .n.ejfTeJibHOCTb:
aMHJIIDI, ffMjl, OT'ieCTBO (npu HaJIHl.JIDI): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

2

(M)')f{CKOH, )f{eHCKHH)
CrpaxoBoH. HOMep HH.D:HBH)J;)'aJibHoro nHIJ.eBoro c'-leTa: __________________

f pIDK)J.aHCTBO: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~
ll:aHHble .D:OK)'MeHTa, y,n:oCTOBepHIOll(ero nH'lHOCTb pe6eHKa:
PeKBH3HTbI 3aIIHcH aKTa o po)f()J.eHHH HnH CBH.D:eTeJibCTBa o po)f()J.eHHH: ___________

Cse,n:eHIDI o .n:pyrHx .n:e-rnx B ceMbe .D:JIH onpe.n:eneHHH pa3Mepa KOMnettcawrn B cooTBe'fCTBHH c qacTbIO
CTaTbH 65 e.n:epanbHOro 3aKOHa «06 o6pa3oBaHHH B PoccHHCKOH e.n:epaiurn»:

5

(l\>aMHJIIDl, HMH, OT'IeCTBO (npH Ha.JIH'IHH); .naTa pO)KJleHIDI; non; CTPaXOBOH HOMep IDUl.HBff.llYa.JibHOfO
JIHIJ;esoro cqeTa; rpIDK.nattcTBo; .naHHhie .noK)'MeHTa, y.nocTosepsnomero JIH'{HOCTb)

Cse,n:eHHH 06 o6yl.feHHH .n:pyrHX .n:e-reH. B ceMhe B B03pacTe OT 18 ne-r no O'IBOH opMe 06yqeHHJ1
(B cnyqae eCJIH TaKHe .D;e'fH HMeIOTCJI B ceMbe):
(HaHMeHOBaHHe o6pa30BaTeJThHOH opraHH3amrn)
(peKBH3HTbI cnpasKH c MecTa yqe6b1 cosepmeuuoneTHHX .neTeif, no.nTBep)f{.llaIOmeif o6yqeHHe
no oqHoH l\>opMe B o6pa30BaTeJibHOH opramf3aIUIH mo6oro THna He3aBHCHMO OT ee opraHH3aUHOHHO-npaBOBOH
opMhl (3a HCKJDOqeHHeM o6pa30BaTeJihHOH opraHH3a1um .nonOJIHHTenhHOfO o6pa30BaHIDl) (yKa3blBaeTCH npH
OTCYTCTBHH y TaKOH o6pa3oBaTeJihHOH opraHH3al{HH TeXHffqeCKOH B03MO)f{HOCTH
npe.nocTaBJieHIDJ YKa3aHHhlx cse.neHHii B paMKax Me)f{se.noMCTBeHHoro HHl\>OpMaI.J.HOHHoro B3aHMo.neliCTBIDl)

PeKBH3HTbI .n:oKYMeHTOB, npe,n:cTaBAAeMbIX B cooTBe'fCTBHH c nyttKTaMH 11 u 13 e,n:uHoro cTatt,n:apTa
npe.n:ocraBJieHIDI rocy,n:apCTBeHHon H (HJIH) MYHffU.HnaJibHOH ycnyrH <e,n:epaQHH», yTBep)f()J.eHHoro nocTattOBJieHHeM IlpaBHTeJibCTBa PoccHHCKOH e,n:epaLI.HH OT 27.05.2023 N!!
829 «06 yTBep)f()J.eHHH e,n:HHoro CTatt.n:aPTa npe,n:OCTaBJieHHH rocy.n:apcTBeHHOH H (HJIH) MYHHU.HilaJibHOH
ycnyrH «BbIIlJiaTa KOMIIeucau,HH qacTH po,n:HTeJibCKOH IlJiaTbl 3a npHCMOTP H yxo.n: 3a ,I\e'fbMH B
rocy,n:apcTBeHHhIX H MYHHQHilaJibHbIX o6pa3oBaTeJibHbIX opraHH3au,HHX, HaxOMi.nHXCH Ha TeppHTOpHH
coOTBe'fCTBYJOll(ero cy6beKTa PoccH8cKon e.n:epau,HID>

KoMnettcau.mo nporny nepe'IHCJIHTb nocpe,n:CTBOM (no Bb16opy 3aHBHTeAA):
qepe3 opraHH3au,mo IlO'iTOBOH CBJl3H: y c.r:ryra He npeJJ,OCTaBJIJle'fCJI.
na pacqe-rnbru cqe-r: ________________________________
(uoMep cqeTa; 6aHK nonyqaTeJrn; Em<; Kopp. cqeT; MHH; KITI1)

3
Cnoco6 no.nyqeHIDI pe3yJihTaTa paccMOTpeHIDI 3ruIBJieHIDI: - - - - - - - - - - - - - -

K 3ruIBJiemuo npHJiaraIOTCR:
(nepeqeHb AOK)'MeHTOB, npe,n:CTaBJIReMbIX 3ruIBHTeJieM npH no,n:aqe 3ruIBJieHHR B ynoJIHOMoqeHHbIR opraH)

CBoeBpeMeHHOCTb H )J,OCTOBepHOCTb npe)J,OCTaBJieHIDI
npeAOCTaBJieHIDI KOMneHcawrn rapaHT0py10.

.51,

«_» _______ 20

npH

H3MeHeHHH

OCHOBaHHH

AJIR

(pacmmppOBKa IlO,llllHCH)

(nO,D:IlHCh3ruIBHTeJIR)
)l;aTa 3anoJIHeHID1:

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ro)J,a

---------------------------------~

(.11.0. (npH HaJIH'IHH) pOAHTeJIR (3aKOHHOrO npe)J,CTilBHTeJIR))
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KOMnettcau;KH B cooTBeTCTBKH c TPe6osaHID1MH 3aKOHOAaTeJibCTBa PoccKiicKoH eAepau;HH, BKJIIOqrui c6op,
CHCTeMaTH3au;mo,HaKOilJieHHe,xpatteHHe,YTOqtteHHe(o6HoBJieHHe,H3MeHeHHe),HCilOJih30BaHHe,nepeAaqy
(npeµocTaBneHHe), o6e3JIH'IHBaHHe, 6noKHpoBaHHe, YAaJiemte H yttffqTO)l(eHHe, BcneAYJOineM o6neMe:
1) cpaMKJIIDI, mui:, OTqecTBO (npu HaJiuqu0);
2) AaTil po)l()J,ettIDI;
3) MeCTO po)l()J,eHIDI;
4)CHMJIC;
5) KOHTilKTHblH TeJiecpott;
6) AaHHh1e nacnoprn (cepIDI, HoMep, AaTa Bhl)J,a~, KeM Bbl)J,aH) HJIH KHoro AOKYMeHTil, YAOCTOBepRJOmero
JIKqHOCTb;

7) a)J.pec MecTil )l(HTeJihCTBa (MeCTil npe6b1BaHIDI);
8) HHcpOpMaWfjl 0 BhIIlJiaqeHHhIX cyMMax KOMileHcau;uH:;
9) peKBH3HTbl 6aHKOBCKOro cqern;
10) CBe)J,eHIDI 0 cpe)J,HeeymeBOM )J,OXO)J,e ceMbH.
HacT011inee cornacHe Ha o6pa6oTK)' nepcottaJibHbIX AaHHhIX AeiicTByeT c MOMeHTa noADHCaHHR AaHHoro
3ruiBJieHHR Ha cpoK: 6eccpoqtto.
OTiblB HaCTORIJ.{ero cornacIDI B c.nyqruix, npeeyCMOTPeHHhIX e)J,epaJihHbIM 3aKOHOM OT 27 KIOJIR 2006
ro)J,a N 152-<1>3 "O nepcottaJibHbIX AaHHbIX",
ocymecTBJIReTCH Ha OCHOBaHHH MOero 3ruIBJieHIDI.
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20 ro)J,a
(IlO)J,IlHCb3ruIBHTeJU1)