ARTIKAKO KONTZEJUA Ayuntamiento de Berrioplano Berriobeitiko Udala (Navarra Nafarroa)
INSTANCIA GENERAL / ESKABIDE OROKORRA
__________________________________________________________________(e)k / con DNI n ______________________________________________ NAN zk. duenak / con domicilio en __________________________________________________ kalean / n ________ zk.an / piso _______ solairuan / municipio _________________________ herrian bizi eta / telfono _____________________________________ tel. zk. duenak
EXPONE / ZERA AZALTZEN DUT:
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ SOLICITA / ZERA ESKATZEN DUT: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Artica, a _____ de ___________________de __________ Artikan, ________(e)ko ________________aren ____(e)an Firma/ Sinadura: SRA. PRESIDENTA DEL CONCEJO DE ARTIKA ARTIKAKO KONTZEJUKO PRESIDENTE JAUNARI.