A. V.
1. Vertybės pavadinimas____________________________________________________________
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2. Vertybės vardas ar vardų sąrašas____________________________________________________
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3. Unikalus identifikavimo kodas Kultūros vertybių registre (toliau – Registras) ________________
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4. Vertybės priklausymas kilnojamųjų kultūros vertybių kompleksui (toliau – Kompleksas)_______
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5. Komplekso dalys________________________________________________________________
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6. Vertybės saugojimo vietos adresas__________________________________________________
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7. Lietuvos Respublikos kultūros ministro įsakymo įrašyti vertybę į Registrą išrašas_____________
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8. Kultūrinė vertė__________________________________________________________________
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9. Autorius_______________________________________________________________________
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10. Mokykla, dirbtuvė, gamykla, leidykla_______________________________________________
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11. Sukūrimo / pagaminimo vieta_____________________________________________________
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12. Sukūrimo / pagaminimo laikas____________________________________________________
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13. Stilius________________________________________________________________________
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14. Medžiaga, technika, matmenys____________________________________________________
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15. Signatūros, įrašai, ženklai, herbai, emblemos, etiketės__________________________________
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16. Būklė________________________________________________________________________
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17. Informacija apie atliktus tyrimo, restauravimo ir konservavimo darbus_____________________
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18. Informacija, kad kilnojamoji kultūros vertybė yra viena iš kultūros paveldo statinio vertingųjų savybių
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19. Sankaupa, padėtis, situacija_______________________________________________________
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20. Duomenys apie kilnojamosios kultūros vertybės savininką ar valdytoją____________________
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21. Lietuvos Respublikos Vyriausybės nutarimo skelbti vertybę kultūros paminklu išrašas ir/arba Lietuvos Respublikos Vyriausybės nutarimo panaikinti sprendimą dėl vertybės paskelbimo kultūros paminklu išrašas
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22. Lietuvos Respublikos kultūros ministro įsakymo išbraukti vertybę iš Registro išrašas_________
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23. Fotofiksacija__________________________________________________________________
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24. Duomenys apie paso pildymą
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25. PRIDEDAMA (kita papildoma informacija):
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