CATRE

PRIMARIA COMUNEI SUPLACU DE BARCAU

Subsemnatul/a____________________________________________,
domiciliat/ n localitatea _______________________________ jude BH,
strada __________________________________________ nr. ________
bloc ____ scara ____ etaj ___ ap. ___, telefon ______________________,
fiul/fiica lui ________________________ si al _______________________
posedand BI/CI seria ____, numar __________________, eliberat de
________________________, C.N.P. ______________________________,
Prin prezenta va rog sa binevoiti a- mi aproba inchirierea Caminului
Cultural/Salii de nunti din localitatea______________________________
pentru data de //2013 in vederea ___________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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In speranta ca prezenta va primi un raspuns favorabil va multumesc
anticipat.
Domnului Primar al Comunei Suplacu de Barcau.
Suplacu de Barcau
____/________/ 2013
(data)

Semntura:
______________________