CQNG HbA xA HQI CHU NGHLA VIST NAM

DQc 1?p-1\r d·')-!i:mh pr uc

GiN XIN IHI, eOI, CAP L~I Glly PUEP LAI XI

Lmh gui: Ph"Ong C<fnhstit Ciao tho"g-Cong an tinh QUlJng Nam-Dit

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Nguyen quan : ~--.J2~ )(~)1 ! .~ _.ik.._._.
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Ko-i BKNK thueug tru : To 7 7 /., P~ v,;;b ...T.~ ..__.fl~
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Hien tal eo b] qua n ch~, cui tao tai ch~, dang u~ l~hait6, (Heu U'~ hoac t!ttog thl hanh
an khong.
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T6i dii hoc Hi xe: tai : __ ..__ . . . .
Co gi5y phep Uti xe (ho~c b£U1g hli xe) so :_ _ .._.<itfQ·C tu loai xc :__ __ . ._
Dt; ngh] CC! quan C6ng an cho t6i ducc : (thi, ¥. ~) gi!ly phep lai xe
Loai : _~ .._~~~_ 2r.. .b.~._
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Ly do: __..__._ ..__ ._ _ _ __ . _.__ .:.._ __ .
Xin gl:l-i kCI1l th eo :
- GHiy clnrng nM.ll 16t nglu~p trni)'lig lai xe l:o~c giaJ phep Iai xe.
- 1 giay clumg llh~1l s irc khoe.
- 4. anh ca 3x4 cm (neu Ill. cap lun dliu) 2 anh 3X4 cm (nh Ill. dZ>ic~p Iai)
- Nh frng gifty to' khac : _

To! xin cam doau nh\i'ng dii!u khal tren dA~'la c.itp{~Sll th~t, ntu sal t6i 'Kill holm toan
ch;u trach nhiem.

Ngl.." ..~.l:.thSng :2- ni§m19.2..r-

N,U'(ri lam d<r.l
(Ki vi gni fa hp:&')
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