Бўстонлиқ туман ииб бошлиғи полковник Ш. А. Шермухамедовга

Тел:______________________
А Р И З А

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(аризанинг қисқача мазмуни)
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Аризани ўз қўлим билан тўғри ёздим.

Ариза берувчи: ___________________ ___________________________

(имзо) (ариза берувчининг Ф.И.Ш)

20__ йил «____» ______________

Аризани қабул қилдим: _________________________________________
(аризани қабул қилган шахснинг лавозими, унвони)