SECRETARIA DE SAÚDE
N° DE CADASTRO MODELO
TERMO DE INTIMAÇÃO– SÉRIE 1 00001
USO INTERNO DA REPARTIÇÃO
De acordo com os artigos 576 e 577 do Regulamento aprovado pelo Decreto n° 12.342, fica(m), por este
instrumento, intimado(s) ____________________________________________________________________________
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RESIDENTE À __________________________________________________________________________________
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ESTABELECIDO À ______________________________________________________________________________
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COM __________________________________________________________________________________________
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DATA
RECEBIMENTO: ____/____/____
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ASSINATURA FISCAL
OBS: __________________________________________________________________________________________
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