|
1. _________________________________________________________________
(ishni ko’rib chiqqan organning nomi)
|
1. /_/_/_/
|
|
2. _________________________________________________________________
(huquqbuzarlik sodir etilgan joy)
|
2. /_/_/_/_/_/
|
|
3. _________________________________________________________________
(Daftar bo’yicha ishning ro’yxatdan o’tkazish tartib raqami)
|
3. /_/_/_/_/_/_/
/_/_/_/_/_/_/_/
/_/_/_/_/_/_/_/
|
|
4. _________________________________________________________________
___________________________________________________________________
(ishni ko’rib chiqqan shaxsning F.I.O. va lavozimi)
5. Ish ko’rib chiqilgan sana: _______ yil "____" __________________
6. Kartochkaga tuzatish kiritilgan sana: _______ yil "____" ____________
6.1. Tuzatish kiritish sabablari: "1" - to’ldirishdagi xato.
|
6.1. /_/
|
|
7. Huquqbuzarlikning kvalifikatsiyasi: MJK _____ qismi _______-moddasi
7.1. Huquqbuzarlik sodir etilgan (aniqlangan sana):
_____ yil "____" ___________________
|
|
|
8. Ma’muriy jazo choralari (MJKning 23-moddasi):
8.1. asosiylari: "1" - jarima
|
8.1. /_/
|
|
9. Jarima miqdori ________________________________so’m.
|
|
|
10. _______________________________________________________________
__________________________________________________________________
(huquqbuzarlikni sodir etgan shaxsning F.I.O.)
10.1. Tug’ilgan sanasi: ______ yil "___" ___________________
|
|
|
11. SHaxsini tasdiqlovchi hujjat: "1" - pasport, "2" - yashash guvohnomasi, "3" - fuqaroligi bo’lmagan shaxs guvohnomasi, "4" - haydovchilik guvohnomasi, "5" - harbiy guvohnoma yoki shaxsini tasdiqlovchi guvohnoma
N _____________ _______ yil "___" _______________da berilgan
__________________________________________________________________
__________________________________________________________________
(kim tomonidan berilgan)
|
11. /_/
|
|
12. _______ yil "___" _____________ _________________________________
(ish ko’rib chiqilgan sana va ko’rib chiqqan shaxsning imzosi)
|
|
