聲請撤回告訴狀

Application to Withdraw the Complaint

股別：

Section:

貴署 年度 字第 號聲請人告訴被告

涉嫌 一案，現Combin，願不再追究

，依刑事訴訟法第238條第1項規定，撤回告訴。

The Applicant has filed a complaint to your Office, Case year zhi No. to accuse the defendant

suspected of committing .

Now, the parties have reached a settlement agreed to keep the peace, the Applicant has agreed not to hold the defendant responsible and hereby withdraws the complaint pursuant to Paragraph 1, Article 238 of the Code of Criminal Procedure.

此 致

臺灣宜蘭地方檢察署公鑒

TO

Taiwan Yilan District Prosecutors Office

聲 請 人： （簽名蓋章）

Applicant: (Signature/Stamp)

國民身分證統一編號/護照號碼/居留證號

National ID No./Passport No./Alien Resident Certificate No.

住 址：

Address:

電 話：

Tel.:

中 華 民 國 年 月 日

Date: (mm)/ (dd), (yyyy)