ACTA DE ENTREVISTA

NUC:
Fecha: Carpeta de
Hora: Investigación:

NOMBRE DE
ENTREVISTADO(A)
SE ENTREVISTA A: VICTIMA ( ), TESTIGO ( ), OTRO: _________
DOMICILIO:
SEXO: MASCULINO ( ) EDAD:
FEMENINO ( ) FECHA DE NACIMIENTO:
CORREO ELECTRONICO:
TELEFONO:
OCUPACION:
IDENTIFICACION:

ENTREVISTADOR:
CALIDAD: DEFENSA ( ) ASESOR JURIDICO ( )
LUGAR DE ENTREVISTA:

FUNDAMENTO
Artículos 20,21 párrafo primero de la constitución política de los estados unidos mexicanos,
17, 49, 109, Fracc. XV, 132, 215 y 217 del código nacional de procedimientos penales.

En este acto afirmo que los hechos narrados son ciertos, y protesto conducirme con la
verdad debido a que fui informado por mi entrevistador que en caso contrario por el delito
de falsedad de declaraciones.

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 HECHOS

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ENTREVISTA CONCLUIDA A LAS: ________

ENTREVISTADO

FIRMA