ATTO DI D E L E G A

_l _ sottoscritt ____________________________________________________________________
residente in ___________________________ via _____________________________ n. ________
tel./cell. (obbligatorio) _____________________________________________________________
e-mail/P.E.C. ____________________________________________________________________

Vista la propria richiesta prot. ______________________del_______________________________

Relativa a: _______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
DELEGA
_l _ sig._________________________________________________________________________
residente in ___________________________ via _____________________________ n. ________
tel./cell. (obbligatorio) _____________________________________________________________
e-mail/P.E.C. ____________________________________________________________________
In qualità di 
[ ] Tecnico incaricato
[ ] Altro (specificare) ______________________________________________________________
A
[ ] Visionare/Estrarre copia della documentazione richiesta.
[ ] Procedere al ritiro della pratica, certificazione, attestato, etc….
[ ] Altro_________________________________________________________________________
________________________________________________________________________________

________________ li’ _____________

IL RICHIEDENTE

___________________________

Si allegano copie documenti di identità del sottoscritto e del delegato (obbligatorio)