<p class="MsoNormal"> 黑龙江省双鸭山市双鸭山公证处<span></span> </p> <p class="MsoNormal" align="center" style="text-align:center;"> <b> </b><b>公证申请表</b>（自然人） </p> <div align="center"> <table class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="border:none;width:90%;" align="center"> <tbody> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">姓名<span></span></span> </p> </td> <td width="47" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="48" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">性别<span></span></span> </p> </td> <td width="37" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="55" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">民族<span></span></span> </p> </td> <td width="55" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="55" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">电话<span></span></span> </p> </td> <td width="111" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="64" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">角色<span></span></span> </p> </td> <td width="96" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">出生日期<span></span></span> </p> </td> <td width="186" colspan="5" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="110" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">工作单位<span></span></span> </p> </td> <td width="272" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="110" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">公民身份号码<span></span></span> </p> </td> <td width="110" colspan="3" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="55" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">住址<span></span></span> </p> </td> <td width="382" colspan="6" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="659" colspan="12" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">公证类别<span></span></span> </p> </td> <td width="569" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">公证事项<span></span></span> </p> </td> <td width="569" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">公证用途<span></span></span> </p> </td> <td width="186" colspan="5" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> <td width="65" colspan="2" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">使用地<span></span></span> </p> </td> <td width="317" colspan="4" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">译文语种<span></span></span> </p> </td> <td width="569" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">提供证<span></span></span> </p> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">明材料<span></span></span> </p> </td> <td width="569" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">本申请<span></span></span> </p> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">人保证<span></span></span> </p> </td> <td width="569" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="left"> <span style="font-size:12.0pt;font-family:宋体;">上列所填内容及所提交的全部文件和材料真实无讹，否则，愿承担一切法律责任。<span></span></span> </p> </td> </tr> <tr> <td width="90" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">公证处<span></span></span> </p> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">郑重警告<span></span></span> </p> </td> <td width="569" colspan="11" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal" align="left"> <span style="font-size:12.0pt;font-family:宋体;">任何伪造、变造、盗用、冒用文件、印章、产权证书、票据或以他人名义进行欺诈以及进行合同诈骗等都将可能构成犯罪，受到刑事追究。<span></span></span> </p> </td> </tr> <tr> <td width="659" colspan="12" style="border:solid windowtext 1.0pt;"> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;">申请人（或代理人）签名：<span></span></span> </p> <p class="MsoNormal"> <span style="font-size:12.0pt;font-family:宋体;"> </span> </p> <p class="MsoNormal" align="center" style="text-align:center;"> <span style="font-size:12.0pt;font-family:宋体;">申请日期：<span></span></span> </p> </td> </tr> <tr> <td width="90" style="border:none;"> </td> <td width="21" style="border:none;"> </td> <td width="26" style="border:none;"> </td> <td width="48" style="border:none;"> </td> <td width="37" style="border:none;"> </td> <td width="55" style="border:none;"> </td> <td width="55" style="border:none;"> </td> <td width="10" style="border:none;"> </td> <td width="45" style="border:none;"> </td> <td width="111" style="border:none;"> </td> <td width="64" style="border:none;"> </td> <td width="96" style="border:none;"> <br /> </td> </tr> </tbody> </table> </div>