JUIZADO ESPECIAL CÍVEL

Data do Comparecimento: ___/___/___ Data do Retorno: ___/___/___

Atendimento feito por:______________ Liminar: ( ) Sim ( ) Não

Parte Autora: _______________________________________________________

RG nº_________________________ CPF/CNPJ____________________________

e-mail: ______________________________________________________________

Data de Nascimento ___/___/___ Profissão ________________________________

Estado Civil_____________________ Nacionalidade_________________________ Caso haja

Endereço____________________________________________________________ mais partes

Bairro_______________________ Cidade___________________ Estado________ no processo

CEP _________-______ Telefones_______________________________________ utilizar o

Parte Ré: ___________________________________________________________ verso desta

RG nº________________________ CPF/CNPJ_____________________________ folha. ( ) →

Data de Nascimento ___/___/___ Profissão ________________________________

Estado Civil _______________________Nacionalidade _______________________

Endereço ____________________________________________________________

Bairro ___________________ Cidade _____________________ Estado__________

CEP _________-_____ Telefones_________________________________________

HISTÓRICO (Resumo dos Fatos)

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PEDIDO: Requer que a parte ré seja condenada a_______________________________________________

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Valor da Causa R$____________________ Assinatura _____________________________________________