| | | | | | | | | | | |т. д.|
| | | +-----+---+---+---+---+---+-----+ | | | | | | |
| | | | 2 | 1 | 2 | 3 | 6 | 9 | и | | | | | | | |
| | | | | | | | | |т. д.| | | | | | | |
-----------+-------+------+---------+-----+---+---+---+---+---+-----+-----+---+---+---+---+--+-----+-----------
| | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | |
"___"____________19___г. Подпись_____________