Professional Documents
Culture Documents
11 Avenida n 1272 Setor Leste Universitrio Goinia-GO, CEP: 74.605-060 PABX: (62) 3265-1300 Fax: (62) 3202-3358
www.secima.go.gov.br
REQUERIMENTO
1) Solicitao para obteno de:
ESTADO DE GOIS
SECRETARIA DE MEIO AMBIENTE, RECURSOS HDRICOS, INFRAESTRUTURA, CIDADES E
ASSUNTOS METROPOLITANOS
11 Avenida n 1272 Setor Leste Universitrio Goinia-GO, CEP: 74.605-060 PABX: (62) 3265-1300 Fax: (62) 3202-3358
www.secima.go.gov.br
REQUERIMENTO
Licena Prvia LP Licena de Explorao Florestal LEF:
2) Atividade:
CNAE: ______________ Atividade Principal: _________________________________________________
Atividade a ser Licenciada: _______________________________________________________________
_____________________________________________________________________________________
4) Dados do Cliente:
Nome/Razo Social:_____________________________________________________________________
Nome
Fantasia:_________________________________________________________________________
CPF/CNPJ: ________________________________ IE/CI: ____________________________________
Endereo Residencial/Localizao: _________________________________________________________
CEP: _________ - ______ Municpio: ___________________________________________ UF: ________
Coord. Geog.: Latitude: _____________________________ Longitude:____________________________
Coord. UTM: X: ___________________________________ Y: _________________________________
Tel.:( ) _______________Fax:( )_______________ Cel:( )______________ Cx. Postal:___________
Site:_________________________________________________________________________________
E-mail:_______________________________________________________________________________
Incio das Atividades: ______/______/_________ Porte: ( ) Micro ( ) Pequeno ( ) Mdio ( ) Grande
5) Contato:
Endereo Correspondncia: _______________________________________________________________
CEP: _________ - ______ Municpio: ___________________________________________ UF: ________
Tel.:( ) _______________Fax:( )_______________ Cel:( )______________ Cx. Postal:___________
Site: _________________________________________________________________________________
E-mail: _______________________________________________________________________________
Nome: _______________________________________________________________________________
11 Avenida n 1272 Setor Leste Universitrio Goinia-GO, CEP: 74.605-060 PABX: (62) 3265-1300 Fax: (62) 3202-3358
www.secima.go.gov.br
REQUERIMENTO
Coord. Geog.: Latitute: _____________________________ Longitude:____________________________
Coord. UTM: X: ___________________________________ Y: _________________________________
Tel.:( ) ________________Fax:( )________________ Cel:( )_____________ Cx. Postal:__________
Outros Municpios/UF:___________________________________________________________________
9) Responsvel Tcnico:
Nome:_____________________________________________Profisso:___________________________
CPF/CNPJ:______________________CI/IE:__________________Registro Profissional:_______________
Endereo: ____________________________________________________________________________
CEP: _________ - ______ Municpio: ___________________________________________ UF: ________
Tel.:( ) ______________Fax:( )_______________ Cel:( )______________ Cx. Postal:____________
Site: _________________________________________________________________________________
E-mail: _______________________________________________________________________________
10) Procurador:
Nome:_____________________________________________Profisso:___________________________
CPF/CNPJ:______________________CI/IE:__________________Registro Profissional:_______________
Endereo Correspondncia: _______________________________________________________________
CEP: _________________ - ________ Municpio: ___________________________________ UF: ______
Tel.:( ) ______________Fax:( )_______________ Cel:( )______________ Cx. Postal:____________
Site: _________________________________________________________________________________
E-mail: _______________________________________________________________________________
Nmero de Documentos Anexos: ___________________________________________________________
______________________________________________________________________________________
Declaro para os devidos fins, que o desenvolvimento das atividades relacionadas neste requerimento
realizar-se-o de acordo com os dados transcritos e anexos supramencionados, pelo que venho requerer
Secretaria do Meio Ambiente e Recursos e Hdricos do Estado de Gois.
Assinatura: ____________________________________________________________________________
Nome: ________________________________________________________________________________
Cargo:_________________________________________________________________________________