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<strong>BAO</strong>. 75. zk. 2016, apirilak 21. Osteguna — 8308 — <strong>BOB</strong> núm. 75. Jueves, 21 de abril de 2016<br />

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ESKAERA OROKORRA<br />

SOLICITUD GENERAL<br />

ESKARIA AURKEZTEN DUEN PERTSONA EDO ENTITATEA<br />

PERSONA O ENTIDAD QUE PRESENTA LA SOLICITUD<br />

Izena eta bi abizenak / Nombre y dos apellidos<br />

Noren ordezkarintzan / En representación de<br />

NAN /DNI<br />

IFK / NIF NAN /DNI<br />

Ondorengoa naizen aldetik / En calidad de<br />

Kalea /Calle Zk. /Nº Solairua /Piso Aldea / Mano<br />

Posta-kodea /CódigoPostal Herria / Municipio / Provincia<br />

e-posta / e-mail Telefono zk. /Nº teléfono Sakelakoaren zk. / Nº móvil<br />

Harremanetarako hizkuntza / Idioma de relación: Euskera Castellano<br />

Baimena ematen dute nire datuak Udaleko datu-basean sar daitezen, udal informaziorako soilik<br />

Autorizo que mis datos formen parte de la base de datos del Ayuntamiento únicamente para efectos informativos municipales<br />

BAI /SI EZ /NO<br />

ESKAERAREN DATUAK /DATOS DE LA SOLICITUD<br />

Gertaerak, arrazoiak, eskaera zehatza/ Hechos, razones, petición detallada<br />

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ERANTSITAKO DOKUMENTZAIOA/ DOCUMENTACIÓN QUE SE ADJUNTA:<br />

1. ________________________________________________________________________________<br />

2. ________________________________________________________________________________<br />

3. ________________________________________________________________________________<br />

4. ________________________________________________________________________________<br />

5. ________________________________________________________________________________<br />

Data / Fecha: ____________________<br />

Sinadura / Firma:<br />

cve: <strong>BAO</strong>-<strong>BOB</strong>-<strong>2016a075</strong>

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