Guvernul Romaniei
DECLARA?IE PE PROPRIE R?SPUNDERESubsemnatul........................................................................................................................Domiciliat ?n........................................................................................................................Cu re?edin?a ?n fapt ?n........................................................................................................N?scut/n?scut? ?n data de....................................?n localitatea.........................................Declar pe proprie r?spundere, cunosc?nd prevederile articolului 326 din Codul Penal privind falsul ?n declara?ii, c? m? deplasez ?n afara locuin?ei, ?n intervalul orar ................ din urm?torul motiv: ..............................................................................................................................................................................................................................................................................................................................................................................................................................Data:Semn?tura: ................
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