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F-ATD-18 Versão C 04/12/2018

DECLARAÇÃO DE SOLICITAÇÃO DE ISENÇÃO DE DÉBITOS

Eu _________________________________________________________________________,
portador do RG ________________________ e CPF_________________________________
solicito______________________________________________________________________
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Endereço da Instalação:
Rua/Av _____________________________________________ Bairro ___________________
Município ________________________________________CEP ________________________

São Paulo, ______ de _____________________ de ________.

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Nome do Solicitante

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RG / CPF

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Assinatura do Solicitante

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