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ΑΙΤΗΣΗ
ΕΠΩΝΥΜΟ:
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ΌΝΟΜΑ :
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ΌΝΟΜΑ ΠΑΤΕΡΑ:
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| ΟΝΟΜΑ ΜΗΤΕΡΑΣ: ........................................................................... |
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ΤΟΠΟΣ ΓΕΝΝΗΣΕΩΣ
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ΈΤΟΣ ΓΕΝΝΗΣΕΩΣ
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ΤΟΠΟΣ ΚΑΤΟΙΚΙΑΣ
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ΟΔΟΣ ......................................... ΑΡΙΘΜ..... |
ΑΡΙΘΜΟΣ ΑΣΤΥΝ. ΤΑΥΤΟΤΗΤΑΣ
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ΜΥΤΙΛΗΝΗ
.........................................200.... |
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ΠΡΟΣ
Τ......... κ. Ειρηνοδίκη Μυτιλήνης
Παρακαλώ να δεχθείτε να ορκισθώ
και να βεβαιώσω ότι είναι αλήθεια ότι:
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Με τιμή
Ο/Η Αιτ..... ...........
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