26

TE R M O D E R E S P O N S A B IL ID A D E

E u ,_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , p o r ta d o r do C P F /M F

_____________________, r e s id e n te e d o m ic ilia d o

_______________________________________________________,

T E L E F O N E :_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , D E C L A R O m e r e s p o n s a b iliz a r p e lo

acesso ao ___________________, p o r ta n to os s e g u in te s

o b je to s :_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

________________________________________________________

________________________________________________________

________________________________________________, bem

com o, m e r e s p o n s a b iliz o C IV IL e C R IM IN A L M E N T E por e v e n tu a is

d a n o s c a u s a d o s e m d e c o r r ê n c ia d a p o s s e d e ta is o b je to s .

_ _ _ _ _ _ _ _ _ _ _ _ _ _ , _ _ - _ _ _ /_ _ _ _ /_ _ _ _ _

_________________________________________

( A s s in a tu r a d o D e c la r a n te )