DOMNULE COMANDANT

        Subsemnatul........................................................., cu domiciliul stabil/sediul in

localitatea.......................................,str...............................................,nr.......,sc.....,

ap.......,sector...............,judet....................................

Detinator al vehiculului:

        - numar de inmatriculare____________________

        - marca_________________________________

        - serie sasiu______________________________

        - culoare________________________________

        -an de fabricatie__________________________

solicit preschimbarea:

                    c   certificatului de inmatriculare

                    c   numerelor de inmatriculare

Am luat la cunostinta ca punerea in circulatie a unui vehicul radiat constituie infractiune.

Alte mentiuni________________________________________________________

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DATA                                                                                        SEMNATURA