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NOME: _______________________________________________________________________
CPF: _________________________________________________________________________
Telefone:______________________________e-mail:__________________________________
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3) Possui dependentes?
( )NÃO ( )SIM
DEPENDENTE (Nome completo, CPF, data de nascimento)
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10) Teve rendimentos isentos (poupança, saque FGTS, distribuição de lucros, dentre outros)?
( ) NÃO ( ) SIM
11) Teve rendimentos sujeitos a tributação exclusiva (aplicação financeira, participação nos
lucros da empresa como empregado, dentre outros)?
( )NÃO ( ) SIM
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Assinatura
(21) 96754-5260 | E-mail: lmendesrangel@gmail.com
Documentos necessários para a elaboração da declaração: