ILMO SENHOR DELEGADO REGIONAL DE POLÍCIA DE....................................

REQUERIMENTO

Eu_______________________________________________________________________

RG n° _____________CPF n°___________________________ residente e domiciliado à

rua _________________________________________________________ n°___________

Bairro: ___________________________ Município: _______________________________

Proprietário: ______________________________ Placa: ____________________________

Renavam: _________________________ Chassi: __________________________________

Vem através deste requerer a Vossa Senhoria, ______________________________________

___________________________________________________________________________
___________________________________________________________________________

NESTE TERMOS
PEDE DEFERIMENTO

Pará_______de__________________2023

Requerente_______________________________________________________
ASSINATURA