PREFEITURA MUNICIPAL DE CAMPO GRANDE

ESTADO DE MATO GROSSO DO SUL

AGNCIA MUNICIPAL DE TRANSPORTE E TRNSITO - AGETRAN

DEFESA DE AUTUAO
RECORRENTE (condutor do veculo):
Endereo:

N:

Complemento:

Bairro:

Cidade:

CEP:

Telefone para contato:

E-mail:

UF:

DESCRIO DO VECULO
Marca:
Cor Predominante:

Modelo:

Ano Fab.:
Placa:

Cidade:

UF:

N AUTO DE INFRAO

SENHOR DIRETOR-PRESIDENTE, PELOS MOTIVOS EXPOSTOS ABAIXO, SOLICITO CANCELAMENTO

DA REFERIDA AUTUAO:
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Campo Grande (MS), ____/____/_______
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Assinatura do Requerente