ÌÁÎÓ ÑÎØ ñ.Øåëêàíîâî

                                                                                                                                                                                    îò __________________________________________________________

                                                                                                                                                                                                                                            (Ô.È.Î. ãðàæäàíèíà; íàèìåíîâàíèå îðãàíèçàöèè, Ô.È.Î. ëèöà, ïðåäñòàâëÿþùåãî îðãàíèçàöèþ)

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                                                                                                                                                                                    (ìåñòî æèòåëüñòâà, òåëåôîí; àäðåñ îðãàíèçàöèè, òåëåôîí)                                                                                                                                                                                                                                                ____________________________________________________________

ÎÁÐÀÙÅÍÈÅ

ãðàæäàíèíà, ïðåäñòàâèòåëÿ îðãàíèçàöèè ïî ôàêòàì êîððóïöèîííûõ ïðàâîíàðóøåíèé

                                                                            Ñîîáùàþ, ÷òî:

                                                            1. ________________________________________________________________

(Ô.È.Î. ãðàæäàíñêîãî ñëóæàùåãî)

                                                            2._________________________________________________________________

(îïèñàíèå îáñòîÿòåëüñòâ, ïðè êîòîðûõ çàÿâèòåëþ ñòàëî èçâåñòíî î ñëó÷àÿõ ñîâåðøåíèÿ

êîððóïöèîííûõ ïðàâîíàðóøåíèé ãðàæäàíñêèì ñëóæàùèì)

                                                            3. ________________________________________________________________

(ïîäðîáíûå ñâåäåíèÿ î êîððóïöèîííûõ ïðàâîíàðóøåíèÿõ, êîòîðûå ñîâåðøèë ãðàæäàíñêèé ñëóæàùèé)

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                                                            4. ________________________________________________________________

(ìàòåðèàëû, ïîäòâåðæäàþùèå Âàøå îáðàùåíèå, ïðè íàëè÷èè)

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                                                                            _______________                                                                                                                                       ______________________________

                                                                                     (äàòà)                                                                                                                                                                                                                (ïîäïèñü, èíèöèàëû è ôàìèëèÿ)