FORMULARIO DEINCLUSION |] EXCLUSION] CONTRATACION] —_NGRESOIZL sseNE2 nor 4
tos datos deen ragistrarse sin omisiones. Usarpreferentemente letra Imprents, Las omisiones, enmiendas o tachaduras,
‘serén motivas de rechazo de esta solid sin excepeién.
DECLARO BAJO FE DE JURAMENTO que mis datos y los de ls personas precedentemente detalladas son verdaderos. Asimismo
‘asumo las consecuencias legales que implican la falsedad del contenido del presente instrumento,
DATOS DEL FUNCIONARIO TITULAR
ombresy Apetios: __UANA-WLCE CABALLERO KRAUSE Doe. N#: 1634878 Rue: 16845788 |
Nac: 03/07/1982. Edad: 38AR0S _Wacionalidad: PARAGUAY Estado Cit ASAD Sexo: _FEMENINO
midis 24 De sehemb
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