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Hoja N°      

ANEXO DECLARACION JURADA R - 500 N° DE CONTRIBUYENTE N° DE EMPRESA

Art. 13 y 14 Ley 15.852            

IDENTIFICACION DE PADRONES IDENTIFICACION DE TITULARES / OCUPANTES


COD. DPTO. SEC. JUD. N° PADRON NOMBRE O DENOMINACION DOMICILIO N° EMPRESA
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   
                                   

FECHA DE PRESENTACION FIRMA (Titular o Apoderado) ACLARACION DE FIRMA DOC. IDENTIDAD

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NORM. Y DISEÑO Ndel 050 182

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