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Promotoria de UnaTRIAGEM N ____________Data: ______/_____/2009 Horrio: ______________Nome: ___________________________________________________ RG _________________________Estado civil: _______________ ro!iss"o: _______________________ Nascime#to: _________________E#dere$o: _____________________________________________________________________________%airro: _____________________________ &idade: __________________________ Estado: __________Tele!o#e's(: '( Reside#cial: _____________'( Tra)al*o: _____________'( &el+lar :______________RE,-M. D., /AT.,:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Noti!icado'a(/co#vidado'a(: ____________________________________________________________E#dere$o: __________________________________________________________________________%airro: ____________________________ Tel0: ____________________ &idade: _________________Marcado 1ara o dia: _____/_____/20234 5s _____*______ mi#0Esta6irio'a(: _______________________ romotor'a( de 7+sti$a:Dr'a(0 _______________________'( &om1arece+8 '( N"o com1arece+0,ol+$"o: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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