Către,

Primarul Comunei Șag Roșu Flavius Alin

Nr:__________din:____________

CERERE
PENTRU EMITERE ADEVERINŢĂ
Subsemnatul(*1_________________________________________________________ cu

domiciliul (*2)/sediul, în judeţul _______ ____________________/municipiul/oraşul/comuna

__________________________ satul ________________ sectorul ____________cod poştal

________________strada_________________________________ nr_____ bl. ____sc. ___

et___ ap__ telefon/fax _______________________________e-mail ___________________

În conformitate cu legislaţia în vigoare, solicit emiterea unei adeverinţe, pentru imobilul -

teren şi/sau construcţii - situat in judetul Timiș, municipiul /oraşul/comuna Șag, satul
_____________________sectorul _________ cod poştal 307395, strada________________
__________________________________ nr________ bl_______ sc_______ et__________
ap_______ sau identificat prin(*3)_______________________________________________
__________________________________________________________________________

__________________________________________________________________________

Solicit adeverinţa in scopul(*4): _______________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Anexez (*3_______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Data ________________ SEMNATURA