Spett.
le
_____________________
MODELLO PER DELEGA
Il/La sottoscritto/a ____________________________________nat_ il ______________________
a ________________________________ residente a _____________________________________
via __________________________________ n. _____________ tel. n. ______________________
C.F. ______________________________________ e-mail:________________________________
DELEGA
Il/La Sig./Sig.ra ______________________________________ nat_ il ______________________
a _______________________________ residente a ______________________________________
via _________________________________ n. _____________ tel. n. _______________________
C.F. ______________________________________ e-mail:________________________________
documento d’identità n. ____________________________________________________________
rilasciato da __________________________ il _________________________________________
ad espletare il seguente adempimento:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Data, ______________________ Firma ___________________________
Allegato:
copia documento di riconoscimento soggetto delegante
copia documento di riconoscimento soggetto delegato
