Sie sind auf Seite 1von 1

Se anexa Hoja N°       Hoja N°       de      

DECLARACION JURADA DE PADRONES RURALES (SUPERFICIE REAL) N° DE EMPRESA


Art. 13 y 14 Ley 15.852
N°      
R-500      

NOMBRE O DENOMINACION TELEFONO O FAX N° DE CONTRIBUYENTE


                 

DATOS DEL PADRON OCUPACION / EXPLOTACION DESVINCULACION


COD. SEC. LOCALIDAD N° INDICE TOTAL CODIGO DE FECHA HAS HAS. EXPL HAS. NO EXON. Y/O DESGR. COD.
FECHA
DPTO. JUD. CATASTRAL PADRON CONEAT HAS. TENENCIA DESDE EXPLOTADAS POR 3ROS EXPLOTADAS HAS. COD. CAUSAL CAUSAL
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         
                                                                                         

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


TIMBRE

      /       /       PROFESIONAL                  

NORM. Y DISEÑO Ndel 050 181

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