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DICHIARAZIONE SOSTITUTIVA DELL\rquote ATTO DI NOTORIETA\rquote 
\par }\pard\plain \s15\qc \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\b\fs28\lang1036\langfe1040\langnp1036\insrsid1595324\charrsid5640241 (Art. 47 D.P.R. 28 dicembre 2000, n. 445)
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\par }{\b\fs20\ul\insrsid1595324\charrsid5640241 DA PRODURRE A PRIVATI}{\ul\insrsid1595324\charrsid5640241 
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Il/la sottoscritto/a _____________________________________________________________________
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                                                                       (cognome)                                                                    (nome)
\par }{\fs24\insrsid1595324 nato/a a ___________________________________________ (__________) il _____________________
\par }{\insrsid1595324                               (luogo)                                                                                        (prov.)
\par }{\fs24\insrsid1595324 residente a ______________________ (_____) in Via____________________________________n. ___
\par }{\insrsid1595324                                 (luogo)                                   (prov.)                                               (indirizzo)
\par }\pard\plain \s16\ql \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 \fs24\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\insrsid1595324 consapevole delle sanzioni penali, nel caso di dichiarazioni  non 
veritiere, di formazione o uso di atti falsi, richiamate dall\rquote art. 76 del D.P.R. 445 del 28 dicembre 2000
\par 
\par }\pard \s16\qc \li0\ri0\sl480\slmult1\widctlpar\faauto\adjustright\rin0\lin0\itap0 {\b\insrsid1595324 DICHIARA}{\insrsid1595324 
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\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85
\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85..
\par }\pard\plain \qj \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\fs24\insrsid1595324 Dichiara inoltre di essere informato, ai sensi e per gli effetti di cui all'art.13 }{
\fs24\insrsid1595324\charrsid6752378 del\~D.Lsg. 196/2003}{\fs24\insrsid1595324 , che i dati personali raccolti saranno 
trattati, anche con strumenti informatici, esclusivamente nell'ambito del procedimento per il quale la presente dichiarazione viene resa.
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\par \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85.
\par }\pard \s16\ql \li0\ri0\sl360\slmult1\widctlpar\faauto\adjustright\rin0\lin0\itap0 {\insrsid1595324                  (luogo, data)}{\fs16\insrsid1595324 
\par }\pard \s16\ql \fi709\li0\ri0\sl360\slmult1\widctlpar\faauto\adjustright\rin0\lin0\itap0 {\fs16\insrsid1595324 \tab \tab \tab \tab \tab \tab \tab }{\b\insrsid1595324 Il Dichiarante
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\par 
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\par }\pard \qj \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 {\fs24\insrsid1595324 Ai sensi dell\rquote art. 21 del DPR 28.12.2000, n. 445, attesto che la sottoscrizione sopra riportata \'e8
 stata apposta dinanzi a me dal Sig. ____________________________________________________ , identificato previa esibizione di ____________________________n\'b0
 _______________ rilasciato il ______________________________ da _________________________________
\par 
\par 
\par _________________________
\par }{\insrsid1595324                 (luogo, data)
\par 
\par                                                                                            Timbro
\par                                                                                        dell\rquote Ufficio                            
\par }\pard \qj \fi709\li5672\ri0\widctlpar\faauto\adjustright\rin0\lin5672\itap0 {\insrsid1595324 ___________________________________
\par }\pard \qj \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 {\insrsid1595324                                                           
                                                                                      (firma del pubblico ufficiale){\*\bkmkend OLE_LINK1}
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