DOMNULE PRIMAR,

Subsemnatul ____________________________________________, cu domiciliul in

________________________________, str.__________________, nr.______, bl.______,
sc.______, et._____, ap.____, judetul_____________, solicit eliberarea unei adeverinte de
rol agricol:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Mentionez ca imi este necesara pentru :
___________________________________________________________________________
___________________________________________________________________________

Data :

Semnatura