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NR.

_____/___________

DOMNULE PRIMAR,

Subsemnatul(a)_______________________________________________,cu domiciliul in localitatea

__________________________,strada,_______________________________________, nr.__________,
telefon mobil_________________________,

(descrierea pe scurt a problemei)

Aduc în atenţia dvs:
_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________
_____________________________________________________________________________________

_____________________________________________________________________________________

Menționarea clară a soluțiilor dorite:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Data: Semnatura

Domnului Primar al Comunei Bralostita

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