PREFEITURA

DE GOIÂNIA SMT – Secretaria Municipal de Trânsito,

ânsito, Transportes e Mobilidade

FORMULÁRIO PARA ENTRADA DE PROCESSO

525 – ( ) RECURSO À JARI 575 – ( ) DEFESA PRÉVIA

À SECRETARIA MUNICIPAL
AL DE TRÂNSITO, TRANSPORTES E MO
MOBILIDADE
BILIDADE – SMT

NESTA

EU __________________________________________________________________________
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Condutor do Veículo: PLACA __________

_________________ MARCA ______________MODELO
________MODELO_____________________

Nº CNH________________________ Nº Auto de Infração______________________________________________

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Residente e domiciliado à: ________________

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mediante o previsto no CTB e resolução do CONTRAN, bem como, requerer o cancelamento pelas razões a seguir:

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Nestes termos,

Pede deferimento.

Goiânia ______
____ de _________________________ de 20_______.

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Assinatura

Anexar cópia:

I. Carteira Nacional de Habilitação (CNH);

II. Certificado de Registro e Licenciamento do Veículo (CRLV);
III. Cópia da Notificação de Autuação e/ou Penalidade// ou PA2 (espelho da infração).

Obs.: Dar entrada em qualquer. Atende Fácil ou Postado nos Correios para o
endereço: Av. Laudelino Gomes Nr. 250 St. Bela Vista Goiânia/GO Cep:74830-090.
Cep:74830