Está en la página 1de 1

REPUBLICA DE COLOMBIA SISTEMA DE GESTION DE VERSION 1

ALCALDIA DE SAN JOSE DE CALIDAD Y SISTEMA DE


CUCUTA CONTROL INTERNO VIGENCIA JUNIO 2011

Misional de la Gestión Municipal INSPECCION QUINTA URBANA Gestión de Convivencia y


DE POLICIA Seguridad Ciudadana
Calle 18 N° 11-61 La Libertad

San José de Cúcuta RAD N°

YO, MAYOR DE EDAD, IDENTIFICADO(A)

CON C.C N° __________________ EXPEDIDA EN______________ CELULAR_______________

RESIDENTE EN ____________________________________________________________________

ME PERMITO DENUNCIAR AL SEÑOR (A)________________________________________________

RESIDENTE EN _____________________________________POR LOS SIGUIENTES HECHOS:

COMPROMISO DE CONVIVENCIA: ( ) CONCILIACION: ( )

HECHOS
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Atentamente: TEL:
C.C BARRIO:
CORREO:

También podría gustarte