PREFEITURA DO MUNICÍPIO DE MAUÁ

PROCESSO ___________________

FOLHA ______ RUBRICA ________

REQUERIMENTO - PADRÃO

À(Ao)
      :

Eu,       , nascido a    /    /      ,

portador do RG       e CPF       , domiciliado na
(rua/av.)       ,
nº       , complemento       ,
bairro       , cidade       ,
estado       , CEP       , inscrição municipal       ,
telefone       , e-mail       ,
venho por meio deste requerer:
     
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Declara o Requerente que as informações aqui contidas correspondem a expressão da verdade, sujeitando-se o
infrator em crime de falsidade documental prevista no Código Penal.

Nestes Termos,
Pede Deferimento

Mauá,    de       de 20   

     
Requerente (Assinatura) Atendente (Nome e Assinatura)
CÓDIGO

VS.14

AV. JOÃO RAMALHO, Nº 205, VILA NOÊMIA, MAUÁ, SP, CEP 09371-520,
098

FONE 4512-7500, CNPJ 46.522.959-0001-98, INSCR. EST. ISENTA, SITE www.maua.sp.gov.br