Fecha: __, ___, ____

ACTA DE RESPONSABILIDAD N° 001

Por este medio, Yo, _____________________________________ me responsabilizo de los

elementos detallados en la sección “Lista”, los mismos que pertenecen al vehículo con placa
________ perteneciente a ___________________. Desde hoy hasta __________________
_______________________________.

Lista.

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Observaciones:
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Atentamente:

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Dirección: Taller Mecánico- N77 Joaquín Mancheno OE1-725 y Juan Barrezueta

Oficinas: Calle Los Ángeles Nº 52-223 y San Rafael Sector el Inca.
Telf.: (593) 02479430