You are on page 1of 1

ACTA DE RECEPCION DE MENORES DE EDAD

En Distrito de Santa Rosa Alto Yanajanca, siendo las_______horas, del


día___/____/____, se hizo presente ante el suscrito, la persona
de___________________________________, de ( ) años de edad, natural
de________________, estado civil_______________ identificado(a) con
DNI_________________, de ocupación___________________________________,
con domicilio en el Distrito de Santa Rosa de Alto Yanajanca, Provincia de Marañón,
Departamento de Huánuco;____________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

RECIBI CONFORME ENTREGUE CONFORME

_______________________ _________________________

You might also like