\documentclass[12pt]{article}

\usepackage{russcorr}

\usepackage{psboxit}

\pagestyle{empty}

%\addtolength{\topmargin}{-30mm}
\addtolength{\textheight}{60mm}
\addtolength{\oddsidemargin}{-20mm}
\addtolength{\textwidth}{40mm}

\def\spp{$\underline{\hspace{50mm}}$}
\def\spq{$\underline{\hspace{20mm}}$}
\def\spr{$\underline{\hspace{36mm}}$}

\def\mc{\multicolumn{2}{|c|}}

\def\dtt{{Дата\hspace{1em}}}
\def\pdp{{Подпись\hspace{1em}}}

\def\grd{\psboxit{box .7 setgray fill}{\phantom{\dtt}}\vphantom{666}}
\def\grp{\psboxit{box .7 setgray fill}{\phantom{\pdp}}\vphantom{666}}

\def\cl{\cline{2-4}}

\begin{document}

{\bf\large Фамилия\spp Школа, город\spp}

\medskip

{\bf\large Год окончания школы\spq Где учитесь днем\spr}

\bigskip

\begin{center}
\begin{tabular}{ccc}

\multicolumn{2}{c}{{\large Алгебра 3}}& {\large Геометрия 1}\\[3mm]

\begin{tabular}[t]
{|c|c|@{}c@{}|@{}c@{}|}
\hline
\mc{$N^0$} & \dtt & \pdp\\
\hline
\mc{1} &&\\
\hline
\mc{2} &&\\
\hline
\mc{3} &&\\
\hline
\mc{4} &&\\
\hline
\mc{5} &&\\
\hline
6 &а &&\\
\cl
&б &&\\
\hline
\mc{7} &&\\
\hline
\mc{8} &&\\
\hline
\mc{9} &&\\
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\mc{10} &&\\
\hline
\mc{11} &&\\
\hline
\mc{12*} &\grd&\grp\\
\hline
\mc{13} &&\\
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\mc{14} &&\\
\hline
\mc{15*} &\grd&\grp\\
\hline
\mc{16*} &\grd&\grp\\
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\mc{17*} &\grd&\grp\\
\hline
\mc{18} &&\\
\hline
\mc{19} &&\\
\hline
20&а &&\\
\cl
&б &&\\
\hline
\mc{21} &&\\
\hline
\mc{22} &&\\
\hline
\mc{23} &&\\
\hline
\mc{24} &&\\
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\mc{25} &&\\
\hline
\mc{26} &&\\
\hline
\mc{27} &&\\
\hline
\mc{28} &&\\
\hline
\mc{29} &&\\
\hline
\end{tabular}&

\begin{tabular}[t]
{|c|c|@{}c@{}|@{}c@{}|}
\hline
\mc{$N^0$} & \dtt & \pdp\\
\hline
\mc{30} &&\\
\hline
\mc{31!} &\grd&\grp\\
\hline
\mc{32} &&\\
\hline
\mc{33!} &\grd&\grp\\
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\mc{34!} &\grd&\grp\\
\hline
\mc{35} &&\\
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\mc{36} &&\\
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\mc{37} &&\\
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\mc{38} &&\\
\hline
\mc{39!} &\grd&\grp\\
\hline
\mc{40**} &\grd&\grp\\
\hline
\mc{41} &&\\
\hline
\mc{42*} &\grd&\grp\\
\hline
\mc{43*} &\grd&\grp\\
\hline
\mc{44!} &\grd&\grp\\
\hline
\mc{45} &&\\
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\mc{46*} &\grd&\grp\\
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\mc{47} &&\\
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\mc{48!} &\grd&\grp\\
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\mc{49*} &\grd&\grp\\
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\mc{50} &&\\
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\mc{51} &&\\
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\mc{52} &&\\
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\mc{53!} &\grd&\grp\\
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\mc{54!} &\grd&\grp\\
\hline
\mc{55*} &\grd&\grp\\
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\mc{56*} &\grd&\grp\\
\hline
\mc{57} &&\\
\hline
\mc{58*} &\grd&\grp\\
\hline
\mc{59*} &\grd&\grp\\
\hline
\mc{60*} &\grd&\grp\\
\hline

\end{tabular}&

\begin{tabular}[t]
{|c|c|@{}c@{}|@{}c@{}|}
\hline
\mc{$N^0$} & \dtt & \pdp\\
\hline
\mc{1} &&\\
\hline
\mc{2} &&\\
\hline
\mc{3} &&\\
\hline
\mc{4!} &\grd&\grp\\
\hline
\mc{5} &&\\
\hline
\mc{6} &&\\
\hline
\mc{7} &&\\
\hline
\mc{8!} &\grd&\grp\\
\hline
\mc{9!} &\grd&\grp\\
\hline
\mc{10} &&\\
\hline
\mc{11} &&\\
\hline
\mc{12} &&\\
\hline
\mc{13} &&\\
\hline
\mc{14} &&\\
\hline
\mc{15} &&\\
\hline
\mc{16} &&\\
\hline
\mc{17} &&\\
\hline
\mc{18} &&\\
\hline
\mc{19} &&\\
\hline
\mc{20!} &\grd&\grp\\
\hline
\mc{21} &&\\
\hline
\mc{22} &&\\
\hline
\mc{23} &&\\
\hline
\mc{24*} &\grd&\grp\\
\hline
\mc{25*} &\grd&\grp\\
\hline
\mc{26**} &\grd&\grp\\
\hline
\mc{27} &&\\
\hline
\mc{28!} &\grd&\grp\\
\hline
\mc{29!} &\grd&\grp\\
\hline
\end{tabular}

\end{tabular}
\end{center}

\end{document}
