Образец явки с повинной


                                                                                            Руководителю следственного   
                                                                                            управления Следственного комитета    
                                                                                            Российской Федерации по Тверской области                   

                                                                                            

                                                                                            генерал-майору юстиции                 

                                                                                            А.А. Кублякову     

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                                                                                           (данные заявителя: Ф.И.О., место регистрации)    

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                                                                                                (данные паспорта или иного документа,  
                                                                                                          удостоверяющего личность)     

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                                                                       Заявление  о явке

                                                                           с повинной 


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(место составления)

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(излагаются обстоятельства преступления: место, время, способ совершенного преступления, _____________________________________________________________________________________________ 
 сведения о лице, совершившем преступление, характере и размере вреда, причиненного преступлением) _____________________________________________________________________________________________
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Заявление составлено собственноручно.  

Об ответственности за заведомо ложный донос по ст. 306 УК РФ предупрежден__


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                                                                                                                                              (подпись заявителя)