KIYMETLİ EVRAK VE DEĞERLİ ŞEYLERİN ALINDI MAKBUZU

                     T.C.

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

Dosya No :………………………………

KIYMETLİ EVRAK VE DEĞERLİ ŞEYLERİN ALINDI MAKBUZU

Esas defter No : …………………………………….                       Makbuz No : ……………………………

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

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

Teslim  alınan  şeyin                                                            Takdir edilen kıymeti

      Cinsi  ve  niteliği                           Miktarı                     Lira                           Kuruş 

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

kalem ayniyat alınmıştır.  ……./……/………

Teslim edenin adı,soyadı                                                        İcra Müdürü veya Yrd. 

Adı, soyadı                                                                                        Mühür ve İmza

*: Bu örnek, bu Yönetmelikten önceki uygulamada kullanılan Örnek 41’e karşılık gelmektedir.