|
DICHIARAZIONE SOSTITUTIVA DELLACERTIFICAZIONE DI STATO
DI FAMIGLIA
(Art. 2 Legge 4 gennaio 1968 n. 15) Il sottoscritto _________________________________________________________________ nato a ________________________________________ (_______) il ____________________ DICHIARA che la famiglia convivente si compone di: 1) il dichiarante 2) ____________________________________________________________________________ ______________________________________________________________________________ 3) ____________________________________________________________________________ ______________________________________________________________________________ 4) ____________________________________________________________________________ ______________________________________________________________________________ 5) ____________________________________________________________________________ ______________________________________________________________________________ 6) ____________________________________________________________________________ ______________________________________________________________________________
__________________________ __________________________ (data) (firma da apporre)
|