Domnule Preedinte,

Subsemnatul(a)______________________________________________posesor al actului de
identitate seria______, numrul_________, eliberat de _________________, la data___________, n
calitate de _________________________*, v rog s binevoii a dispune eliberarea de fotocopii de pe
dosarul (dosarele) ntocmite de organele de securitate, privind pe _____________________________
Dosar Fond Penal nr. ____________________
Volum/Filele_______________________________________________________________________
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Menionez c am luat cunotin de faptul c preul unei pagini este de 0,20 lei i c fotocopiile nu vor
cuprinde pasajele ce pot afecta major orice persoan menionat n dosar sub aspectul datelor personale
i/sau al vieii private.
Data_____________

Semntura_______________

A se completa cu titular dosar, rud pn la gradul IV, inclusiv sau cercettor acreditat, dup caz.

Serviciul Buget Finane

ncasat suma de ___________lei, cu chitana ___________din______________
Semntura___________________.
Nume i prenume titular cerere: _____________________________________
Adresa de coresponden:
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Telefon fix: ___________________Telefon mobil: _______________________