DICHIARAZIONE SOSTITUTIVA DELLATTO DI NOTORIETA
(ai sensi dellart. 47 D.P.R. 28/12/2000, n. 445)
DA PRESENTARE ALLA PUBBLICA AMMINISTRAZIONE O AI GESTORI DI PUBBLICI SERVIZI
Il/la sottoscritto/a ___________________________________ C.F. _______________________________
nato/a a _________________________________________________ il ________________ residente a
________________________________________ via _________________________________________
n. _________ tel. ________________________, consapevole delle sanzioni penali previste dallart. 76 del
D.P.R. 28/12/2000, n. 445 per le ipotesi di falsit in atti e dichiarazioni mendaci, sotto la propria
responsabilit
DICHIARA
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Conferisce il consenso al trattamento dei propri dati personali e/o sensibili ai sensi del Decreto Legislativo
196/03 e prende atto delle informazioni di cui allart. 13 del Decreto Legislativo 196/03.
Letto, confermato e sottoscritto.
Cremona, l
___________________________________
Ai sensi dellart. 38, D.P.R. 445 del 28/12/2000, la dichiarazione sottoscritta dallinteressato/a in presenza
del dipendente addetto ovvero sottoscritta o inviata insieme alla fotocopia, non autenticata di un
documento di identit del dichiarante, allufficio competente via fax, tramite un incaricato, oppure a mezzo
posta.
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