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) ____________________________________________________________________________
(cognome) (nome) (rapporto con dichiarante)

______________________________________________________________________________
(nato a) (il)

3) ____________________________________________________________________________

______________________________________________________________________________

4) ____________________________________________________________________________

______________________________________________________________________________

5) ____________________________________________________________________________

______________________________________________________________________________

6) ____________________________________________________________________________

______________________________________________________________________________

 

__________________________ __________________________

(data) (firma da apporre)