docAL COMANDO POLIZIA MUNICIPALE FORLI` OGGETTO: ESPOSTO
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AL COMANDO POLIZIA MUNICIPALE FORLI` OGGETTO: ESPOSTO
T0017 AL COMANDO POLIZIA MUNICIPALE FORLI’ OGGETTO: ESPOSTO/SEGNALAZIONE IN MERITO A: ____________________________ _______________________________________________________________________________________ Il/la sottoscritto/a Cognome_____________________________Nome_____________________________ Data di nascita_________________Comune di nascita ___________________________Provincia______ Comune di residenza______________________________________________________Provincia_______ Via/corso/piazza________________________________________n.________tel._____________________ fax ___________ E-mail___________________________ codice fiscale ___________________________ ESPONE/SEGNALA quanto segue: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Si allega: □ ___________________________________________________________________________________ □ ___________________________________________________________________________________ □ ___________________________________________________________________________________ Forlì,_____________________ Firma dell’interessato ____________________________ Si informa, ai sensi del d.lgs. 196/2003, che i dati personali raccolti sono trattati esclusivamente per la definizione del presente procedimento. ********* SPAZIO RISERVATO ALL’UFFICIO L’esposto/segnalazione è stato inserito nel sistema Rilfedeur con n° _______________ e assegnato in carico all’Unità __________________________
