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Pas
________________________________,
telefone
(DDD
ou
DDI/n)
____________________________________________________________________,
nascido(a)
em
____/____/_______, (DD/MM/AAAA), venho apresentar a Vossa Excelncia, nos termos do art. 7 da Lei
n. 4.737, de 1965, c.c. art. 80, caput e 1, da Res.-TSE n 21.538, de 2003, JUSTIFICATIVA DE AUSNCIA DE
VOTO no(s) turno(s) de votao realizado(s) no(s) ano(s) abaixo especificado(s), pelo(s) motivo(s) que passo a relatar:
TURNO
VOTAO
ANO (especificar)
eleio
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plebiscito
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referendo
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Termos em que
Peo deferimento
_______________________________________________
(local e data)
______________________________________________
(assinatura do(a) eleitor(a))
Documentos comprobatrios anexados:
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