Врио военного комиссара
                                                                                                                                               Вологодской области
                                                                                                                                                             С.Берникову


                                                                                                                                     От ________________________
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                                                                                                                                     Проживающего  по адресу:
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                                                                                                                                      телефон:___________________



                                                                               Заявление
    Прошу выдать справку установленной формы для выезда за пределы Российской Федерации в связи с
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                                                            (дата,подпись,расшифровка)

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