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Nr.

nregistrare _______________/ Data________________

CERERE DE ELIBERARE A UNEI ADEVERINE DE VENIT

Subsemnatul/Subsemnata ____________________________________________
CNP/NIF ____________________, cu domiciliul fiscal n _________________________,
str. ___________________________________, nr _________, bl. _________, sc ____,
ap. ______, etaj _____, judeul/sectorul ___________________, cod potal __________,
telefon __________________________, fax _________________________,

reprezentat/reprezentat prin dl./dna ____________________________________,

CNP/ NIF ____________________ cu domiciliul fiscal n _________________________,

str. ___________________________________, nr _________, bl. _________, sc ____,


ap. ______, etaj _____, judeul/sectorul ___________________, cod potal __________,

posesorul/posesoarea documentului de identitate seria ________ nr. ________________,

eliberat de _____________________________________________,

solicit eliberarea unei adeverine privind situaia veniturilor impozabile pe anul


_________, pentru a servi la _______________________________________________
_______________________________________________________________________.

Numele i prenumele ________________________ Semntura ______________


Data ___________________

cod 14.13.25.13
Numr de operator de date cu caracter personal _______