Modello Delega Accesso Atti

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Modello Delega Accesso Atti

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DELEGA

Il/la sottoscritto/a __________________________________________________________Nato/a a________________________________________________ il ____/____/______Residente in via/piazza ____________________________________________n. _______ Citt ________________________________________Prov._______C.A.P.___________Codice fiscale _______________________________________________Documento di riconoscimento _____________________________n._________________ rilasciato da _____________________________________________ il ____/____/______In qualit di_______________________________________________________________

DELEGAIl sig./la sig.ra____________________________________________________________Nato/a a________________________________________________il ____/____/______Residente in via/piazza __________________________________________n. ________ Citt ________________________________________Prov._______C.A.P.___________Codice fiscale ___________________________________________________ Documento di riconoscimento _____________________________n._________________ rilasciato da _____________________________________________ il ____/____/______

A compiere per proprio conto la seguente operazione: o Richiesta di accesso ai documenti sottoelencatio Ritiro copia dei documenti sottoelencati ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Data ____/____/______ Firma _______________________________ Allegare copia del documento di identit del delegante e del delegato