Ctre,

Ctre,

SERVICIUL PUBLIC COMUNITAR REGIM PERMISE DE CONDUCERE l NMATRICULARE A VEHICULELORSubsemnatul (Subscrisa)

ROTUNDU ANA C.N.P. (C.U.I.) 2580301270646 cu domiciliul (sediul) n PIATRA NEAMT , strada ALE.ULMILOR nr. 37 , bloc A0 , scara B , ap. 78 , jude/sector NEAMT solicit ELIBERAREA UNUI NOU CERTIFICAT DE INMATRICULARE INTRUCAT L-AM PIERDUT (auto)vehiculului marca DACIA cu numrul de identificare(serie asiu) UU1D2F719Y2962680.Data 13.07.2012

Semntura

(si tampila, n cazul persoanelor juridice)Dat n faa mea,

Data:

Numele, prenumele, semntura lucrtor SPCRPCIV

DECLARAIESubsemnatul ROTUNDU ANA

C.N.P.(C.U.I) 2580301270646

cu domiciliul in PIATRA NEAMT

, strada ALE.ULMILOR

,nr.37

, bloc A0

, scara B , ap. 78

, jude/sector NEAMT

, cunoscnd prevederile art. 292 cod penal privind falsul n declaraii, declar pe propria rspundere pierderea/furtul/deteriorarea:

FORMCHECKBOX plcii/plcilor cu numrul de nmatriculare

FORMCHECKBOX certificatul de nmatriculare cu nr.

Data: 13.07.2012

Semntura

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