ESTADO DO MARANHÃO

PREFEITURA MUNICIPAL DE GRAJAÚ

CNPJ/MF nº 06.377.063/0001-48
SECRETARIA MUNICIPAL DE FAZENDA E HABITAÇÃO
Rua Patrocínio Jorge, 05 – Centro-CEP 65940-000
Site: www.grajau.ma.gov.br / E-
mail:habitacaograjau2017@gmail.com

FICHA DE VISITA DOMICILIAR

DADOS PESSOIAS
NOME: ____________________________________________________________________
CPF: _________________________ RG: ___________________ Data Nasc: ___/___/_____
ESTADO CIVIL________________Profissão:________________ Contato:___________
ENDEREÇO:_______________________________________________________________
NOME: DO CONJUJE:
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CPF: ______________________ RG: ____________________Data Nasc: ______________
PARTICIPA DE ALGUM PROGRAMA SOCIAL?____________________________________
POSSUI PESSOAS COM NECESSIDDAES NESPECIAIS NA FAMILIA?_________________
POSSUI RENDA?___________________________________________________________
QUAL TIPO DE OCUPAÇÃO?
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Grajaú – MA, ____ / ____ / 2021.

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Assinatura do entrevistado Assistente Social