Chihuahua, Chih.

, a _______ de _______________________ de _________

YO C_____________________________________________ RECIBO DE LA COMISION EJECUTIVA DE ATENCION A

VICTIMAS DEL ESTADO DE CHIHUAHUA; LOS SIGUIENTES APOYOS:

APOYOS EN EFECTIVO
ALIMENTOS $_______________ (_____________________________________________________________________)
UBER $_______________ (_____________________________________________________________________)
TAXI $_______________ (_____________________________________________________________________)
DIDI $_______________ (_____________________________________________________________________)
TREN $_______________ (_____________________________________________________________________)
AUTOBUS $_______________ (_____________________________________________________________________)
GASOLINA $_______________ (_____________________________________________________________________)
CASETAS $_______________ (_____________________________________________________________________)
VUELOS $_______________ (_____________________________________________________________________)
MEDICAMENTOS $_______________ (____________________________________________________________________)
CAMBIO DE ROPA $______________ (_____________________________________________________________________)
ASEO PERSONAL $______________ (_____________________________________________________________________)
HOSPEDAJE $_______________ (____________________________________________________________________)
OTROS $________________ (____________________________________________________________________)
_______________________________________________________________________________________________________
TOTAL, DEL APOYO BRINDADO $ _______________ (________________________________________________________)

APOYOS CON PROVEEDORES

ALIMENTOS $______________ (_____________________________________________________________________)
HOSPEDAJE $______________ (____________________________________________________________________)
TOTAL, DEL APOYO BRINDADO $ _______________ (________________________________________________________)
ACOMPAÑANTES DE LA VICTIMA:
VICTIMA PARENTESCO NOMBRE EDAD FIRMA
1.- ______________ ___________________ _______________________________________ _____ _________________

2.- ______________ ___________________ _______________________________________ ______ ________________

3.- ______________ ___________________ _______________________________________ ______ ________________

4.- ______________ ____________________ _______________________________________ ______ ________________

5.- ______________ ___________________ ________________________________________ ______ ________________

ATENTAMENTE