Załącznik Nr 2 do Regulaminu korzystania 
z materiałów archiwalnych  w Archiwum Państwowym we Wrocławiu

Nazwy zespołów (zbiorów) archiwalnych objętych Zgłoszeniem użytkownika zasobu archiwalnego	

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

..........................................................................................................................................................................

data                                                                                                                        podpis