SELF-DECLARATION
(in compliance with art.  47 of  D.P.R. n. 445/2000)
I, the undersigned ________________ Tax Code ____________________ born in ________________ State _________________,
on _____________ and resident in ____________ State ______________
Aware of the criminal liability in case of mendacious declaration as provided for by art. 76, Presidential Decree n. 445 of  28 December 2000

DECLARE

that _____________________________


Date ______________ 

Signature

 ________________
 
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