2012 Anexa 1 - Cerere de Internare_varstnici
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Transcript of 2012 Anexa 1 - Cerere de Internare_varstnici
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Anexa 1 JUDEUL HUNEDOARA PRIMRIA .. NR.. din ..
Cerere internare
Subsemnatul (a)_________________________________
________________ domiciliat (a) ______________________,
str.______________________ nr. ____, bl. _______, ap. ____
telefon _____________, posesor BI / CI / CP seria _____ nr.
________________ solicit internarea d-nei / d-lui_________
______________________________________, grad de
rudenie __________ domiciliat (a) n ___________________ str. _______________________, nr. _____, bl. ______, ap.
______, telefon _____________, posesor BI / CI / CP seria
_____ nr. ______________, persoana vrstnic (da / nu) n centrul ______________________ aflat n coordonarea Direciei Generale de Asisten Social i Protecia Copilului Hunedoara, deoarece:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Data Semntura solicitant
___________________ ________________________________