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PREFEITURA MUNICIPAL DE CAMPO GRANDE
ESTADO DE MATO GROSSO DO SUL
AGÊNCIA MUNICIPAL DE TRANSPORTE E TRÂNSITO - AGETRAN
DEFESA DE AUTUAÇÃORECORRENTE (condutor do veículo):
Endereço: Nº:
Complemento: Bairro:
Cidade: CEP: UF:
Telefone para contato: E-mail:
DESCRIÇÃO DO VEÍCULO
Marca: Modelo: Ano Fab.:
Cor Predominante: Placa: Cidade: UF:
Nº AUTO DE INFRAÇÃO
SENHOR DIRETOR-PRESIDENTE, PELOS MOTIVOS EXPOSTOS ABAIXO, SOLICITO CANCELAMENTO DA REFERIDA AUTUAÇÃO:
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Campo Grande (MS), ____/____/_______
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Assinatura do Requerente