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AL SIG. GIUDICE DI PACE DI BUSTO ARSIZIO
AL SIG. GIUDICE DI PACE DI BUSTO ARSIZIO CON SEDE IN GALLARATE IN VIALE MILANO, 21 RICORSO ex art. 204/bis D. L. vo 285/92 Il sottoscritto _____________________________________________________________ residente a ______________________________ in via ___________________________ e per gli effetti del presente atto domiciliato a Busto Arsizio in via ____________________ ______________________________ (oppure presso la Cancelleria dell’Ufficio del Giudice di Pace) PREMESSO che in data _____________ gli è stato notificato ordinanza-ingiunzione verbale n. _____________________ emesso da _______________________________________ di ___________________________________in data _____________________________ con il quale veniva comminata la sanzione amministrativa pari a Euro ________________ per la violazione alle norme del vigente CdS di cui all’art. __________________________ commessa a _______________________________________ in data ________________ RICORRE contro l’accertamento e la contestazione di cui sopra per i seguenti MOTIVI ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ A suffragio di quanto sopra indica i seguenti mezzi di prova: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Per tutto quanto sopra espresso il sottoscritto CHIEDE che il Sig. Giudice di Pace voglia annullare il provvedimento impugnato e che __________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Allega tre copie del provvedimento impugnato debitamente notificato oltre alla seguente documentazione: __________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Busto Arsizio, ______________________ firma ___________________________
