PREFEITURA MUNICIPAL DE CIDADE

SECRETARIA DE SAÚDE

N° DE CADASTRO MODELO
TERMO DE INTIMAÇÃO– SÉRIE 1 00001
USO INTERNO DA REPARTIÇÃO

De acordo com os artigos 576 e 577 do Regulamento aprovado pelo Decreto n° 12.342, fica(m), por este
instrumento, intimado(s) ____________________________________________________________________________
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RESIDENTE À __________________________________________________________________________________
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ESTABELECIDO À ______________________________________________________________________________
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COM __________________________________________________________________________________________
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A EXECUTAR NO PRAZO DE _____ DIAS, O seguinte: ________________________________________________

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SOB PENA DE, não o fazendo, sujeitar-se às penalidades previstas no Artigo 568 do Regulamento acima referido.

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DATA

RECEBIMENTO: ____/____/____

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ASSINATURA FISCAL
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