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                             DOMNULE NOTAR PUBLIC,
   Subsemnatul(a) ……….., domiciliat(a) in …………., mostenitor al defunctului(ei) …………, decedat(a) la …………, in …………., cu ultimul domiciliu in ………., succesiune dezbatuta si in urma careia s-a eliberat certificatul de mostenitor nr. …….. din ………. din care au fost omise urmatoarele bunuri: ……………………………….
   De aceea, in temeiul art. 86 alin 2 din Legea nr. 36/1995, va rog sa fixati un termen la care sa fie citati ceilalti mostenitori si anume:
   1. ………….;
   2. …………., etc, carora sa li se ceara consimtamantul in vederea eliberarii unui supliment de certificat de mostenitor, in care sa fie cuprinse si bunurile succesorale omise.
   Depun cererea in …… exemplare, pentru a se trimite tuturor mostenitorilor si chitanta de plata a taxei de timbru in valoare de ………..lei.
   Data depunerii
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 Semnatura,
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   DOMNULUI NOTAR PUBLIC ………………..

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