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UNIDADE SÃO JOSÉ DOS CAMPOS

DECLARAÇÃO DE TESTEMUNHA

Nome do assistido:___________________________________________________________

Testemunha
Nome: _________________________________________________________________________________________________________________________________________

RG: _______________________________________________________________________ CPF: _____________________________________________________________

Profissão: _______________________________________________ Nacionalidade: ________________________________________________________

Estado Civil: ___________________________________________________________ Telefone: __________________________________________________

Endereço: ___________________________________________________________________________________________________________________________________

Bairro: _______________________________________________________ Cidade: ___________________________________________________________________

Estado: ________________________________________________________________ CEP: _____________________________________________________________

Declaro sob as penas da lei que:


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São José dos Campos, ____/____/____ Assinatura: ________________________________________
OBS: Trazer xerox de RG, CPF e Comprovante de residência da testemunha

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