r1' 'V \. Avsägelse av förtroendeuppdrag Undertecknad önskar bli entledigad från uppdrag, enligt följande: U ppdrag: ... t:$.?.V,..... \.b.f.:\B.·····"[······················································································ _ Ev. datum: ............................................................................................................................................. Namn: ....~.~~~~-.......(~:.-:-.\~.;;::-.''.5..$.0~(\ ......................................... .. Personnummer: ... Adress:.±~.~\.~.S...0.:.~.\\.d..~~.......~Co............ Postadress:. ... ..5.~-:1:...40.\.........\3..~~.;$.. . . . . . . . . . . . . . . Telefonnr: ...................................................... Datum: ...................../.....................20 .................. . ~) C::". -·_ / __) Underskrif~.-~-<~.~?.~ .........................................................................~·..... . · Skickas/lämnas till expeditionen ~<lii •
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