Bogotá D, C. mes _________ día ______ año _______.

Señores.
COOPERATIVA MIR.
Ciudad.

ASUNTO: ___________________________________________.

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Agradezco la atención prestada.

Cordialmente.

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Firma.
Cedula: _____________________________
Dirección: ___________________________
Celular: _____________________________
Correo: _____________________________