Domnule Preşedinte,

Subsemnatul(a)______________________________________________posesor al actului de
identitate seria______, numărul_________, eliberat de _________________, la data___________, în
calitate de _________________________*, vă rog să binevoiţi a dispune eliberarea de fotocopii de pe
dosarul (dosarele) întocmite de organele de securitate, privind pe _____________________________
Dosar Fond Penal nr. ____________________
Volum/Filele_______________________________________________________________________
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Menţionez că am luat cunoştinţă de faptul că preţul unei pagini este de 0,20 lei şi că fotocopiile nu vor
cuprinde pasajele ce pot afecta major orice persoană menţionată în dosar sub aspectul datelor personale
şi/sau al vieţii private.

Data_____________ Semnătura_______________
A se completa cu „titular dosar”, „rudă până la gradul IV, inclusiv” sau „cercetător acreditat”, după caz.

Serviciul Buget – Finanţe

Încasat suma de ___________lei, cu chitanţa ___________din______________
Semnătura___________________.
Nume şi prenume titular cerere: _____________________________________
Adresa de corespondenţă:
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Telefon fix: ___________________Telefon mobil: _______________________