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Esindaja ees- ja perekonnanimi
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Telefon .....................................................................................
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AVALDUS
Palun võtta ……………..…………………………………………………….(nimi) Muhu Hooldekeskuse SA hooldekodu järjekorda.
Kohta vajab alates
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Vajab abi ............................................................................................................................................
(millistes tegevustes)
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Seadusjärgne ülalpidaja/ ülalpidajad või kontaktisik (esindaja) on .......................................................................................................................................................
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Avalduse täitja
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