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О реализации требований Закона Калининградской области "О наградах Калининградской области"

Форма документа, подтверждающего награждение орденом или медалью "За заслуги перед Калининградской областью"

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¦   Герб Калининградской области   ¦                                   ¦

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¦          УДОСТОВЕРЕНИЕ           ¦                                   ¦

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¦         ОРДЕНУ (МЕДАЛИ)          ¦                                   ¦

¦        "ЗА ЗАСЛУГИ ПЕРЕД         ¦                                   ¦

¦    КАЛИНИНГРАДСКОЙ ОБЛАСТЬЮ"     ¦                                   ¦

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¦                N                  ¦                                   ¦

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¦                                  ¦           Награжден(а)            ¦

¦                                  ¦         Орденом (медалью)         ¦

¦                                  ¦ "За заслуги перед Калининградской ¦

¦                                  ¦             областью"             ¦

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¦            (фамилия)             ¦             награда N              ¦

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¦ ________________________________ ¦      Губернатор                   ¦