كلاسه پرونده:.......................... |
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نام و نام خانوادگي شاكي: ....................شغل......................دين....................تابعيت.................تاريخ تولد............... |
نشاني:.........................................................................................................................وكيل: دارد□ ندارد□ |
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نام و نام خانوادگي متشكي عنه: ..................شغل...................دين.................تابعيت................تاريخ تولد............ |
نشاني:.........................................................................................................................وكيل: دارد□ ندارد□ |
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موضوع شكايت: .................................................................................................................................................................... |
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دلايل و مستندات: .............................................................................................................................................................. |
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گزارش ضابطين قضايي: .................................................................................................................................................... |
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گزارش پزشكي قانوني: ....................................................................................................................................................... |
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گزارش ساير مراجع: .......................................................................................................................................................... |
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نوع قرار صادره: ..................................................................................................................................................................... |
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تصميم جلسه اول: ............................................................................................................................................................... |
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تصميم جلسه دوم: .............................................................................................................................................................. |
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تصميم جلسه سوم: ............................................................................................................................................................. |
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تصميم قاضي: |
كيفر خواست:.......................................................................................................................................................................... |
قرار منع تعقيب:..................................................................................................................................................................... |
قرار موقوفي تعقيب:.............................................................................................................................................................. |
ساير:........................................................................................................................................................................................... |
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تنظيم كننده: ...................................................... |
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فرم شماره 2163/2201/24 دفتر تشكيلات و برنامه‌ريزي |
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