1. _________________________________________________________________
(ishni ko’rib chiqqan organning nomi)
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1. /_/_/_/
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2. _________________________________________________________________
(huquqbuzarlik sodir etilgan joy)
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2. /_/_/_/_/_/
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3. _________________________________________________________________
(Daftar bo’yicha ishning ro’yxatdan o’tkazish tartib raqami)
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3. /_/_/_/_/_/_/
/_/_/_/_/_/_/_/
/_/_/_/_/_/_/_/
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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.
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6.1. /_/
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7. Huquqbuzarlikning kvalifikatsiyasi: MJK _____ qismi _______-moddasi
7.1. Huquqbuzarlik sodir etilgan (aniqlangan sana):
_____ yil "____" ___________________
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8. Ma’muriy jazo choralari (MJKning 23-moddasi):
8.1. asosiylari: "1" - jarima
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8.1. /_/
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9. Jarima miqdori ________________________________so’m.
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10. _______________________________________________________________
__________________________________________________________________
(huquqbuzarlikni sodir etgan shaxsning F.I.O.)
10.1. Tug’ilgan sanasi: ______ yil "___" ___________________
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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)
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11. /_/
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12. _______ yil "___" _____________ _________________________________
(ish ko’rib chiqilgan sana va ko’rib chiqqan shaxsning imzosi)
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