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{"sheet":"WNIOSEK","index":0,"n_rows":96,"n_cols":23,"rows_kept":96,"cut":false,"hidden":false,"merged":[[65,1,65,13],[79,2,79,25],[70,1,70,25],[21,15,21,22],[34,1,34,24],[73,3,73,19],[32,1,32,24],[66,1,66,25],[71,2,71,13],[48,1,48,10],[55,14,55,24],[69,2,69,24],[67,12,67,14],[68,1,68,24],[72,2,72,25],[67,15,67,18],[40,1,40,24],[94,1,94,25],[73,20,73,21],[73,22,73,23],[76,2,76,25],[85,1,85,25],[93,1,93,24],[89,13,89,24],[89,1,89,6],[88,1,88,6],[88,13,88,24],[78,2,78,25],[77,2,77,25],[83,2,83,25],[82,2,82,25],[81,2,81,25],[80,2,80,25],[3,1,3,24],[57,1,57,25],[59,12,59,19],[60,12,60,19],[33,1,33,24],[35,1,35,24],[36,1,36,24],[13,1,13,24],[43,1,43,25],[10,1,10,24],[7,1,7,25],[22,15,22,24],[64,1,64,25],[61,12,61,19],[59,4,59,11],[60,4,60,11],[47,11,47,14],[53,1,53,24],[61,4,61,11],[52,1,52,25],[49,1,49,3],[54,2,54,24],[56,2,56,24],[55,1,55,7],[63,1,63,24],[0,22,0,24],[44,1,44,16],[44,17,44,22],[47,1,47,10],[71,17,71,18],[71,15,71,16],[15,1,15,10],[17,1,17,24],[19,1,19,24],[12,1,12,24],[45,1,45,3],[28,1,28,24],[22,1,22,13],[30,1,30,24],[26,1,26,24],[41,11,41,17]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"W-AZBEST"]
[]
[]
[null," WNIOSEK  O  DOTACJĘ\nw ramach programu priorytetowego NFOŚiGW pod nazwą \n „Ogólnopolski program finansowania usuwania wyrobów zawierających azbest”\n"]
[null,"Data rejestracji ..............................................."]
[null,"Wpisano do rejestru pod nr ............................"]
[]
[null,"CZĘŚĆ I.  DANE DOTYCZĄCE WNIOSKODAWCY:"]
[null,"1.Dane Wnioskodawcy"]
[null,"Nazwa "]
[]
[null,"Adres"]
[]
[]
[null,"Numer telefonu"]
[]
[]
[]
[null,"Adres e-mail"]
[]
[null,"2. Numery:"]
[null," N I P :",null,null,null,null,null,null,null,null,null,null,null,null,null,"REGON:"]
[]
[]
[null,"3. Osoba prowadząca sprawę:"]
[null,"Imię i nazwisko"]
[]
[null,"Numer telefonu"]
[]
[null,"Adres e-mail"]
[]
[null,"4.  Rachunek bankowy Wnioskodawcy, na który należy przekazać dotację:"]
[null,"Numer konta bankowego"]
[]
[null,{"$f":"CONCATENATE(MID(B34,1,2),\" \",MID(B34,3,4),\" \",MID(B34,7,4),\" \",MID(B34,11,4),\" \",MID(B34,15,4),\" \",MID(B34,19,4),\" \",MID(B34,23,4))","v":"      "}]
[null,"Nazwa banku"]
[]
[]
[null,"5.  Czy wnioskodawca prowadzi działalność gospodarczą"]
[]
[null,"6. Wartość wskaźnika G dochodów podatkowych na jednego mieszkańca w gminie, o których mowa  w ustawie z dnia 13 listopada 2003 r. o dochodach jednostek samorządu terytorialnego (t.j. Dz.U z 2018 r. "]
[null,"poz. 1530 z póź. zm.)  na rok 2020 wynosi: ",null,null,null,null,null,null,null,null,null,{"$f":"Pomocnicz!J10","v":"Wskaźnik G \n na 2020 r."}]
[]
[null,"CZĘŚĆ II. WNIOSEK "]
[null,"1. Wnioskujemy o przyznanie dotacji na rok 2021 r. w kwocie: ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!I12","v":6100}]
[null,"  słownie: ",null,null,null,{"$f":"Słownie(R45)","v":"sześć tysięcy sto złotych "}]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"    "]
[null,"2. Koszt  kwalifikowany zadania :",null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!F11","v":{"$error":"#N/A"}}]
[]
[null,"  słownie: ",null,null,null,{"$f":"Słownie(L48)","v":{"$error":"#VALUE!"}}]
[]
[]
[null,"Wyliczony koszt kwalifikowany zadania stanowi minimalny koszt kwalifikowany do poniesienia przy wnioskowanej kwocie dotacji, uwzględniający wskaźnik G gminy (zgodnie z ust. 5.2 pkt 1-3 \"Procedury dofinansowania przedsięwzięć dotyczących usuwania azbestu i wyrobów zawierających azbest przez WFOŚiGW w Rzeszowie\")"]
[null,"3. Oświadczenie o podatku VAT"]
[null,null,"Oświadczamy, że w przypadku niniejszego zadania podatek VAT stanowi  koszt ponoszony na jego realizację i  nie przysługuje  prawo jego odliczenia/odzyskania  zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2021.685 t.j.)"]
[]
[null,null,"Oświadczamy, że w przypadku niniejszego zadania podatek VAT nie stanowi kosztu ponoszonego na jego realizację i przysługuje prawo jego odliczenia/odzyskania zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2021.685 t.j.)"]
[null,"4. Plan finansowania zadania w zł:"]
[]
[null,null,null,null,"dotacja WFOŚiGW  ",null,null,null,null,null,null,null,{"$f":"Harmonogram!$I$11","v":1794.12},null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!N10","v":1}]
[null,null,null,null,"dotacja NFOŚiGW",null,null,null,null,null,null,null,{"$f":"Harmonogram!$J$11","v":4305.88}]
[null,null,null,null,"inne źródła finansowania/środki własne",null,null,null,null,null,null,null,{"$f":"Harmonogram!$L$11","v":{"$error":"#N/A"}}]
[]
[]
[null,"5. Dotacja zostanie przeznaczona na finansowanie zadania p.n.: "]
[null,"Usuwanie wyrobów zawierających azbest z terenu Gminy ",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!J1","v":"GMINA"}]
[null,"6. Planowany termin płatności:"]
[null,null,"III/IV kwartał:*"]
[null,"*lecz nie później niż do dnia 25.11.2021 r."]
[]
[null,"\n7. Przewidywany efekt rzeczowy i ekologiczny:\n"]
[null,null,"Planowana minimalna ilość odpadów do unieszkodliwienia:",null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"Harmonogram!$D$11","v":17.428571428571427},null,"Mg"]
[null,null,"Wyliczona minimalna ilość odpadów zawierających azbest do unieszkodliwienia stanowi iloraz wnioskowanej kwoty dofinansowania i jednostkowego kosztu 350 zł/Mg (na podstawie ust. 5.2 pkt 4 \"Procedury dofinansowania przedsięwzięć dotyczących usuwania azbestu i wyrobów zawierających azbest przez WFOŚiGW w Rzeszowie\")"]
[]
[null,"CZĘŚĆ III. OŚWIADCZENIA (proszę zaznaczyć stosowne oświadczenia)"]
[]
[null,null,"Oświadczam, że Gmina wywiązuje się:\n- z obowiązku uiszczania opłat za korzystanie ze środowiska i administracyjnych kar pieniężnych wynikających z ustawy Prawo Ochrony Środowiska,\n- ze świadczeń publicznoprawnych na rzecz Zakładu Ubezpieczeń Społecznych,   \n- ze świadczeń publicznoprawnych na rzecz Urzędu Skarbowego,\n- z zobowiązań w stosunku do Funduszu wynikających z wcześniej zawartych umów."]
[null,null,"Oświadczam, że Gmina wywiązuje się z zobowiązań cywilnoprawnych na rzecz NFOŚiGW;"]
[null,null,"Oświadczam, że na terenie Gminy  przeprowadzono inwentaryzację wyrobów zawierających azbest;"]
[null,null,"Oświadczam, że Gmina posiada Uchwałę Rady Gminy zatwierdzającą Gminny program usuwania azbestu lub w przypadku gdy gmina nie posiada własnego programu a należy do związku gmin, który posiada program – uchwałę zatwierdzającą Związkowy program usuwania azbestu oraz oświadczenie wójta (dot. akceptacji Związkowego programu w części dot. gminy);"]
[null,null,"Oświadczam, że wioskowane zadanie jest zgodne z gminnym programem usuwania azbestu i wyrobów zawierających azbest lub przyjętym przez gminę programem związku międzygminnego, którego gmina jest członkiem;"]
[null,null,"Oświadczam, że przy wyborze przedsięwzięć do dofinansowania Gmina weryfikowała stopień pilności usunięcia i unieszkodliwienia lub zabezpieczenia odpadów zawierających azbest;"]
[null,null,"Oświadczam, że Gmina umieści ogłoszenie o zamówieniu w Biuletynie Informacji Publicznej Gminy;  "]
[null,null,"Oświadczam, że Gmina dokona weryfikacji dokumentów potwierdzających uprawnienie Wykonawcy do wykonywania działalności związanej z usuwaniem wyrobów zawierających azbest;  "]
[]
[null,"Świadomi odpowiedzialności karnej wynikającej z art. 233 § 1 Kodeksu karnego za składanie fałszywych zeznań oświadczamy, że zawarte we wniosku dane są zgodne ze stanem faktycznym i prawnym. Wiarygodność podanych we wniosku danych stwierdzamy własnoręcznym podpisem.\n"]
[]
[]
[null,"....................................",null,null,null,null,null,null,null,null,null,null,null,"..............................................................................."]
[null,"/Miejscowość, data/",null,null,null,null,null,null,null,null,null,null,null,"(pieczęć firmowa i podpisy osób upoważnionych do zaciągania zobowiązań majątkowych)"]
[]
[]
[]
[null,"Wykaz dokumentów do wniosku o dotację (W-AZBEST)"]
[null,"Do wniosku o  dotację należy załączyć wymienione niżej dokumenty:"]
[null,"1. Harmonogram finansowo-rzeczowy (załącznik nr 1 do wniosku)."]

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["Usuwanie wyrobów zawierających azbest z terenu Gminy ",null,null,null,null,null,null,null,null,"GMINA",null,null,1]
[]
[null,"Rodzaj robót",null,"Masa odpadów zawierających azbest [Mg]",null,"Koszt kwalifikowany\nzadania [zł]1\n","Termin realizacji\n(dzień, miesiąc, rok)\n",null,"Planowane nakłady finansowe [zł]"]
[]
[]
[]
[null,null,null,null,null,null,"rozpoczęcie","zakończenie2","dotacja\nWFOŚiGW\n","dotacja\nNFOŚiGW\n","netto/brutto\n","środki własne jst/inne"]
[]
[]
[null,"1.",null,"2.",null,"4.","5.","6.","7.","8.","9.","10.",null,1]
[null,"Unieszkodliwianie wyrobów zawierających azbest (demontaż, zbieranie, transport)",null,{"$f":"I12/350","v":17.428571428571427},null,{"$f":"ROUND(I12/Pomocnicz!K10,2)","v":{"$error":"#N/A"}},null,null,{"$f":"I12-J11","v":1794.12},{"$f":"ROUNDDOWN((0.6*I12)/0.85,2)","v":4305.88},{"$f":"IF($N$10=1,\"brutto\",\"netto\")","v":"brutto"},{"$f":"F11-I12","v":{"$error":"#N/A"}}]
[null,null,null,null,null,null,null,null,6100,null,{"$f":"IF($N$10=1,\"brutto\",\"netto\")","v":"brutto"}]
[]
[null,"1 koszt jednostkowy 350 [zł/Mg]"]
[null,"2 data zakończenia zadania nie później niż do dnia 25.10.2021  r."]

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[]
[]
[]
[]
[]
[]
[]
[null,null,null,"Oświadczamy, że w przypadku niniejszego podatek VAT  stanowi / nie stanowi koszt ponoszony na jego realizację i przysługuje / nie przysługuje*  prawo jego odliczenia / odzyskania zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2018.2174 z późn. zm.)"]
[]
[]
[]
[]
[]
[null,null,"Oświadczamy, że w przypadku niniejszego podatek VAT  stanowi / nie stanowi koszt ponoszony na jego realizację i przysługuje / nie przysługuje*  prawo jego odliczenia / odzyskania zgodnie z przepisami ustawy z dnia 11 marca 2004 r. o podatku od towarów i usług (Dz.U.2018.2174 z późn. zm.)"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,"stanowi ",null,"przysługuje",null,"odliczenia"]
[null,null,null,null,null,null,null,"nie stanowi",null,"nie przysługuje",null,"odzyskania"]

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["Kod gminy",null,null,null,"GMINA","Wskaźnik G \n na 2020 r."]
["18","14","02",2,"ADAMÓWKA",811.71]
["18","21","01",2,"BALIGRÓD",1200.77,null,null,null,null,"Przedział"]
["18","20","01",3,"BARANÓW SANDOMIERSKI",1142.44,null,null,null,null,0,0.85]
["18","17","02",2,"BESKO",894.05,null,null,null,null,1501,0.59499999999999997]
["18","10","02",2,"BIAŁOBRZEGI",1108.3900000000001,null,null,null,null,2001,0.34]
["18","13","01",2,"BIRCZA",1015.3]
["18","16","02",3,"BŁAŻOWA",833.5]
["18","16","03",3,"BOGUCHWAŁA",1460.84,null,null,"Gmina ","Wskaznik G","%"]
["18","18","02",2,"BOJANÓW",774.7,null,null,{"$f":"Harmonogram!J1","v":"GMINA"},{"$f":"VLOOKUP(I10,E1:F161,2,FALSE)","v":"Wskaźnik G \n na 2020 r."},{"$f":"VLOOKUP(J10,K4:L6,2,TRUE)","v":{"$error":"#N/A"}}]
["18","11","02",2,"BOROWA",1087.04]
["18","03","02",3,"BRZOSTEK",773.6]
["18","02","01",3,"BRZOZÓW",1090.9100000000001]
["18","05","02",2,"BRZYSKA",733.76]
["18","17","03",2,"BUKOWSKO",1072.81]
["18","04","03",2,"CHŁOPICE",870.63]
["18","16","04",2,"CHMIELNIK",1120.3800000000001,null,"Wskaźnik G - podstawowych dochodów podatkowych  na 1 mieszkańca gminy przyjęty do obliczania subwencji wyrównawczej na 2020 r."]
["18","07","01",2,"CHORKÓWKA",987.09]
["18","09","02",3,"CIESZANÓW",1152.06]
["18","21","02",2,"CISNA",2915.31]
["18","06","01",2,"CMOLAS",777.62]
["18","01","03",2,"CZARNA pow. bieszczadzki",1689.18]
["18","03","03",2,"CZARNA pow. dębicki",1095.17]
["18","10","03",2,"CZARNA pow. łańcucki",1242.79]
["18","11","03",2,"CZERMIN",1138.6300000000001]
["18","19","01",2,"CZUDEC",1073.8800000000001]
["18","03","04",2,"DĘBICA",1692.5]
["18","03","01",1,"DĘBICA - MIASTO",2001.33]
["18","05","03",2,"DĘBOWIEC",720.2]
["18","02","02",2,"DOMARADZ",725.7]
["18","13","02",2,"DUBIECKO",732.55]
["18","07","02",3,"DUKLA",1100.8699999999999]
["18","02","03",2,"DYDNIA",866.22]
["18","16","05",2,"DYNÓW",718.02]
["18","16","01",1,"DYNÓW - MIASTO",1036.82]
["18","06","06",2,"DZIKOWIEC",570.02]
["18","13","03",2,"FREDROPOL",912.07]
["18","19","02",2,"FRYSZTAK",923.22]
["18","14","03",2,"GAĆ",947.58]
["18","11","04",2,"GAWŁUSZOWICE",953.7]
["18","16","06",3,"GŁOGÓW MAŁOPOLSKI",1881.42]
["18","20","02",2,"GORZYCE",1461.32]
["18","20","03",2,"GRĘBÓW",1319.72]
["18","08","02",2,"GRODZISKO DOLNE",999]
["18","02","04",2,"HACZÓW",859.46]
["18","12","01",2,"HARASIUKI",639.54999999999995]
["18","09","03",2,"HORYNIEC-ZDRÓJ",1022.71]
["18","16","07",2,"HYŻNE",796.51]
["18","15","01",2,"IWIERZYCE",1050.98]
["18","07","03",3,"IWONICZ-ZDRÓJ",1038.71]
["18","12","02",2,"JAROCIN",680.78]
["18","04","04",2,"JAROSŁAW",1131.0899999999999]
["18","04","01",1,"JAROSŁAW - MIASTO",1661.91]
["18","02","05",2,"JASIENICA ROSIELNA",829.36]
["18","05","04",2,"JASŁO",973.06]
["18","05","01",1,"JASŁO - MIASTO",1946.1]
["18","07","10",2,"JAŚLISKA",876.43]
["18","14","04",2,"JAWORNIK POLSKI",740.41]
["18","07","04",3,"JEDLICZE",1588.56]
["18","12","03",2,"JEŻOWE",642.61]
["18","03","05",2,"JODŁOWA",728.62]
["18","16","08",2,"KAMIEŃ",785.64]
["18","14","05",3,"KAŃCZUGA",1059.97]
["18","06","02",3,"KOLBUSZOWA",1401.94]
["18","05","05",3,"KOŁACZYCE",747]
["18","17","04",2,"KOMAŃCZA",1343]
["18","07","05",2,"KORCZYNA",1130.23]
["18","13","04",2,"KRASICZYN",1580.74]
["18","16","09",2,"KRASNE",1782.71]
["18","05","06",2,"KREMPNA",845.2]
["18","61","01",1,"KROSNO - MIASTO",2079.63]
["18","07","06",2,"KROŚCIENKO WYŻNE",1179.56]
["18","12","04",2,"KRZESZÓW",846.71]
["18","13","05",2,"KRZYWCZA",629.34]
["18","08","03",2,"KURYŁÓWKA",803.52]
["18","04","05",2,"LASZKI",917.23]
["18","21","03",3,"LESKO",1151.05]
["18","08","04",2,"LEŻAJSK",1046.03]
["18","08","01",1,"LEŻAJSK - MIASTO",1715.81]
["18","09","04",2,"LUBACZÓW",889.29]
["18","09","01",1,"LUBACZÓW - MIASTO",1268.99]
["18","16","10",2,"LUBENIA",1089.02]
["18","01","05",2,"LUTOWISKA",3216.07]
["18","10","04",2,"ŁAŃCUT",1127.1199999999999]
["18","10","01",1,"ŁAŃCUT - MIASTO",1876.43]
["18","06","03",2,"MAJDAN KRÓLEWSKI",669.57]
["18","10","05",2,"MARKOWA",1230.5899999999999]
["18","13","06",2,"MEDYKA",1279.8]
["18","07","07",2,"MIEJSCE PIASTOWE",1019.48]
["18","11","05",2,"MIELEC",1463.73]
["18","11","01",1,"MIELEC - MIASTO",2266.59]
["18","09","05",3,"NAROL",776.35]
["18","19","03",2,"NIEBYLEC",824.61]
["18","12","05",3,"NISKO",1511.42]
["18","06","04",2,"NIWISKA",800.77]
["18","20","04",3,"NOWA DĘBA",1657.1]
["18","08","05",3,"NOWA SARZYNA",1135.23]
["18","05","07",2,"NOWY ŻMIGRÓD",714.07]
["18","02","06",2,"NOZDRZEC",744.39]
["18","09","06",3,"OLESZYCE",1170.8900000000001]
["18","21","04",2,"OLSZANICA",905.39]
["18","13","07",2,"ORŁY",1024.77]
["18","05","08",2,"OSIEK JASIELSKI",677.32]
["18","15","02",2,"OSTRÓW",1300.3499999999999]
["18","11","06",2,"PADEW NARODOWA",1063.8800000000001]
["18","04","06",2,"PAWŁOSIÓW",1130.19]
["18","03","06",3,"PILZNO",1437.43]
["18","04","07",3,"PRUCHNIK",900.34]
["18","11","07",3,"PRZECŁAW",1044.3399999999999]
["18","13","08",2,"PRZEMYŚL",1308.5]
["18","62","01",1,"PRZEMYŚL - MIASTO",1565.4]
["18","14","06",2,"PRZEWORSK",919.41]
["18","14","01",1,"PRZEWORSK - MIASTO",1723.49]
["18","18","03",2,"PYSZNICA",1253.6600000000001]
["18","18","04",2,"RADOMYŚL NAD SANEM",917.07]
["18","11","08",3,"RADOMYŚL WIELKI",1087.8699999999999]
["18","04","08",2,"RADYMNO",1071.9100000000001]
["18","04","02",1,"RADYMNO - MIASTO",1249.44]
["18","10","06",2,"RAKSZAWA",1032.45]
["18","06","05",2,"RANIŻÓW",832.05]
["18","04","09",2,"ROKIETNICA",1241.81]
["18","15","03",3,"ROPCZYCE",1509.26]
["18","04","10",2,"ROŹWIENICA",805.86]
["18","12","06",3,"RUDNIK NAD SANEM",1059.24]
["18","07","08",3,"RYMANÓW",998.86]
["18","63","01",1,"RZESZÓW - MIASTO",2125.35]
["18","17","05",2,"SANOK",1131.67]
["18","17","01",1,"SANOK - MIASTO",1671.59]
["18","15","04",3,"SĘDZISZÓW MAŁOPOLSKI",1230.6400000000001]
["18","14","07",3,"SIENIAWA",998.73]
["18","05","09",2,"SKOŁYSZYN",976.41]
["18","16","11",3,"SOKOŁÓW MAŁOPOLSKI",879.49]
["18","21","05",2,"SOLINA",3154.59]
["18","18","01",1,"STALOWA WOLA - MIASTO",2034.94]
["18","09","07",2,"STARY DZIKÓW",1464.44]
["18","19","04",3,"STRZYŻÓW",1014.2]
["18","13","09",2,"STUBNO",812.98]
["18","16","12",2,"ŚWILCZA",1236.4000000000001]
["18","64","01",1,"TARNOBRZEG - MIASTO",1458.25]
["18","05","11",2,"TARNOWIEC",931.74]
["18","14","08",2,"TRYŃCZA",1242.51]
["18","16","13",2,"TRZEBOWNISKO",1953.13]
["18","11","09",2,"TUSZÓW NARODOWY",1211.4000000000001]
["18","16","14",3,"TYCZYN",1371.86]
["18","17","06",2,"TYRAWA WOŁOSKA",810.89]
["18","12","07",3,"ULANÓW",776.06]
["18","01","08",3,"USTRZYKI DOLNE",1303.3]
["18","11","10",2,"WADOWICE GÓRNE",1186.8399999999999]
["18","04","11",2,"WIĄZOWNICA",1185.8499999999999]
["18","09","08",2,"WIELKIE OCZY",885.11]
["18","15","05",2,"WIELOPOLE SKRZYŃSKIE",639.94000000000005]
["18","19","05",2,"WIŚNIOWA",811.76]
["18","07","09",2,"WOJASZÓWKA",969.81]
["18","17","07",3,"ZAGÓRZ",1210.76]
["18","18","05",3,"ZAKLIKÓW",1056.78]
["18","18","06",2,"ZALESZANY",1278.3599999999999]
["18","17","08",2,"ZARSZYN",949.39]
["18","14","09",2,"ZARZECZE",766.12]
["18","10","07",2,"ŻOŁYNIA",1161.02]
["18","13","10",2,"ŻURAWICA",1343.02]
["18","03","07",2,"ŻYRAKÓW",1357.79]