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DECLARATION

I, Eugnio Azenha Madeira, with the Identity Card number 01353268, with residence in Urbanizao Encosta do Sol, number 27, 2040-223 Rio Maior, come in this way to declare that the documents of the vehicle Golf, model 5, with the license plate MEDC 6060 have been stolen.

Rio Maior, 22 december 2011.

signature ______________________

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