Você está na página 1de 2

FORMULÁRIO PARA APRESENTAÇÃO DE DEFESA

Nome: ___________________________________________________________
CPF/CNPJ:________________________________________________________
Endereço*:_________________________________________ Nº:____________
Complemento:______________________ Bairro:________________________
CEP:______________________ Cidade:______________________ UF:______
Telefone:(___)__________________ E-mail:_____________________________
Auto de Infração nº:______________ Data:_____/______/______
* O endereço informado deve ser um endereço onde o correio tenha acesso.
**A defesa deve ser encaminhada para URS/ULSA que gerou o Auto de
Infração.
_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________
_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Assinatura:____________________________________

Você também pode gostar