Dominika Cendrowicz
Section of the Public Administration System Institute of Administrative Studies
Department of Law, Administration and Economics University of Wrocław
Administrative decision
Superintendent of the Register Office
in XYZthe identification of an authority date of issuanceWrocław, January 21, 2016
DECISION
specification of the legal basisPursuant to the article 4 of the Act of October 17, 2008, of change names and surnames (Journal
of Laws No. 220, item 1414 with further amendments) and pursuant to the article 104 of the Code of Administrative Proceedings of 14 June 1960 (Journal of Laws 2013, item 267 with further amendment – consolidated text, hereinafter referred to as “CAP”), having examined the application Mr Jan Kowalskiidentification of the party
I HEREBY CHANGErulling
the first name of Mr Jan Kowalski, family name: Kowalski, son of: Jerzy and Janina Kowalscy, born: in.……, from name: Jan, to name:
“HENRYK”
REASONSlegal and factual substantiation
Pursuant to article 107 CAP I do not justified the decision as fully complies the interest of the party.
NOTEinstruction on any appellate measures
The party shall have the right to brought an appeal to the Governor of the Lower Silesia Province, through me, within the 14 days of its service.
Pursuant to article 130 § 4 CAP this decision, as being consisted with parties request, is enforceable before the passage of time to brought the appeal.
[In seal with the national emblem of the Republic of Poland] Superintendent of the Registered Office
in XYZ Jan Igresiński
[sign: illegible] a signature with identification of name and surname and official position of the person authorized to issue the decision
Stamp duty in the amount PLN 37 collected
Pursuant to the Stamp Duty Act of November 16, 2006 (Journal of Laws No. 225, item 1635)
Receive: 1. Applicant
