PROCES-VERBAL

de nlturare de la conducerea
vehiculului
___________2015

or.________________
localitatea

data ntocmirii

Agent constatator: IIP al Plut. Hincesti,Leova,Cimislia ______________________

funcia, numele i prenumele

____________________________________________________________________________________
n temeiul art. 431, 432, 438 alin.1 lit. a,b), 439 din Codul contravenional al RM,
astzi ___________________la ora _______ pe str. ___________________________________________
am efectuat nlturarea de la conducerea vehiculului _________________________________________
tipul, modelul, numrul de nmatriculare

a cet. ________________________________________________________________________________________________
numele, prenumele, patronimicul, data, luna, anul naterii

n prezena martorilor (oculari / asisteni ):

____________________________________________________________________________________________
numele, prenumele, patronimicul, domiciliul, telefonul

Temeiul de fapt care a determinat nlturarea de la conducerea vehiculului ___________________

Miros specific de alcool din cavitatea bucal

Autovehiculul a fost adus la parcarea or.____________________________________________________
adresa parcrii

Defectele i deteriorrile vizibile ale vehiculului

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Declaraiile i obieciile persoanei nlturate de la conducerea vehiculului: _____________________________

______________________________________________________________________________________________________
______________________________________________________________________________________________________

Mijloace tehnico-tiinifice utilizate n cadrul nlturrii de la conducerea vehiculului:

Alcotest Drager 6810 nr.________

______________________________________________________________________________________________________

Agent constatator

_______________

(semntur)

Martor

___________________

(semntur)

Persoana nlturat de la conducerea vehiculului _________________

(semntur)