Modello di delega

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          MODELLO DI DELEGA

AL__________ DI ______________

 Il/la Sottoscritt_____________________________________________________________

nat__ a _______________________ il ___________________________________________

e residente a ________________________________ in via ___________________________

                                                           D E L E G A

il/la Sig.___________________________________________________________________

nat___ a ______________________il _____________________________________________

Al _________, presso Codesto Ufficio per____________

_____________________________________________________________________________

Luogo e data _____________________________

                                                                                              Firmato _______________________