Al Signor

Prefetto di Napoli tramite

Servizio Autonomo Polizia Locale
Settore Legale
Ufficio Verbali e Denunzie
Via Pietro Raimondi, 19
80141 Napoli

RICORSO AI SENSI ART. 203 C.d.S.

Riferimento verbale n. ___________________ del ________________ notificato il ______________

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Il sottoscritto________________________________________________________________________

nato a _______________________________________________ il ____________________________

residente in _________________________________________________ prov.___________________

Via ____________________________________________________________________ n _________

telefono____________________________________________________________________________

in qualità di conducente proprietario

del veicolo targato ________________ tipo ______________________

propone RICORSO per i seguenti motivi:

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data ______________________ firma _________________________________