Gobierno de la Ciudad Autónoma de Buenos Aires

POLICÍA DE LA CIUDAD DE BUENOS AIRES

ACTA CIRCUNSTANCIADA
(Arts. 50 y 51 CPPCABA)

En la Ciudad Autónoma de Buenos Aires, República Argentina, a los______ días del mes de
_______________ del año _________ siendo las ________ horas, el funcionario que suscribe
________________ L.P_____________________________________________________ secundado por
_________________ L.P_________________________________________ ambos numerarios
____________________ de esta Policía de la Ciudad, a los efectos legales hace CONSTAR: En
circunstancias que nos encontrábamos recorriendo la jurisdicción en prevención de ilícitos, contravenciones
y faltas, sobre la calle ________________________________________________
_____________________ a bordo del móvil (SI - NO) identificable, (orden-patente) ____________, ya
habiéndose tomado los recaudos de seguridad en cuestión, para salvaguardar la integridad física del
personal actuante y la de terceros, conforme a lo normado en los artículos 50 y 51 del Código de
Procedimiento Penal de la Ciudad Autónoma de Buenos Aires, (Ley 2303). Se solicita la comparecencia
de dos (2) testigos hábiles identificados como1) _________________________________
_____________________de ______ años de edad, de nacionalidad _______________ estado civil
_______________ profesión y/o ocupación ____________ con domicilio particular en calle
_________________________________________________________ titular de (DNI, CIPF, PTE, LE,
LC) N° _____________________ teléfonos: ___________________________ y 2)_________________
____________________________________ de _____ años de edad, de nacionalidad _______________,
estado civil _______________, profesión y/o ocupación _________________ con domicilio particular en
calle _________________________________________ ________________________________ titular
de (DNI, CIPF, PTE, LE, LC) N° ___________________ teléfonos: _________________________ a los
fines de dejar constancia escrita del siguiente hecho:_______________________________________
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Es todo y siendo las ______ horas, se dio por finalizado el acto, previa e integra lectura que se da de la
presente, no teniendo nada más que añadir, quitar, enmendar, tachar o borrar es ratificada por todos los
intervinientes para legal constancia de lo actuado.-------------------------------------------------------------------