RSD ..……………………………… ………………………………………. ^(nazwa jednostki Policji, w której wydano postanowienie)

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(imię i nazwisko podejrzanego (ej)

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(adres)

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UZASADNIENIE POSTANOWIENIA

• O PRZEDSTAWIENIU ZARZUTÓW

• O UZUPEŁNIENIU ZARZUTÓW

• O ZMIANIE ZARZUTÓW

na podstawie art. 313 § 1, 314 * kpk i zgodnie z art. 313 § 2 kpk

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(stopień imię i nazwisko) d d m m r r r r

• przedstawił zarzut (y)

d d m m r r r r

• uzupełnił zarzut (y) przedstawiony (e)

d d m m r r r r

• zmienił zarzut (y) przedstawiony (e)

d d m m r r r r

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(imię i nazwisko podejrzanego)

Dokładne określenie zarzucanego czynu (ów) i jego (ich) kwalifikacji prawnej .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. .................................................................................................................................................................. ..................................................................................................................................................................

Powyższe postanowienie na podstawie art. 313 § 3 i 4, 314 * kpk

uzasadniam

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(wpisać w szczególności fakty i dowody, które przyjęte zostały za podstawę przedstawienia zarzutu (ów)

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(podpis policjanta)

* niepotrzebne skreślić

• postawić znak x w odpowiedniej kratce albo postawić znak x w odpowiedniej kratce i uzupełnić treść

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