DELEGA
Il/La sottoscritto/a ________________________________________________________________ nato/a _________________________________________________ il _______________________ residente in via ____________________________________________________ CAP __________ città _____________________________________________________________ Prov. _________
DELEGA
il/lasig./sig.ra ___________________________________________________________________ nato/a _________________________________________________ il _______________________ residente in via ____________________________________________________ CAP __________ città _____________________________________________________________ Prov. _________
a: (indicare il tipo di operazione per cui si effettua la delega) ______________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________
Il delegante
__________________________ ______________________________ (luogo e data) (firma)