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DOMNULE PRESEDINTE,
Subsemnatul(a) ………….., domiciliat(a) in …………… inculpat(a), parte vatamata, parte civila, parte responsabila civilmente, in dosarul penal nr. ………… al acestei instante, in care s-a pronuntat sentinta penala nr. ……….. din …………
In baza art. 368 C. proc. pen., declar expres ca RENUNT LA DREPTUL DE A DECLARA APEL impotriva hotararii citate.
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DOMNULUI PRESEDINTE AL …………………
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