RICORSI ANAGRAFICI									  Marca
												 da bollo
Mod. 4: contro il provvedimento di cancellazione d’ufficio dall’anagrafe

Al Sig. Prefetto 
della Provincia di
CUNEO

Il/la sottoscritto/a ______________________________________________________ nato/a _____________________ Prov ________  il_____________ Stato __________________ Cittadinanza _______________________ residente a _____________________________ in via __________________________________________ n.__________  CAP _____________  Telefono __________________   E-mail ________________

Compilare solo se diverso dalla residenza:

Indirizzo domicilio ____________________________________  Città _____________________
Prov __________ CAP _____________ presso ________________________________________

R I C O R R E

ai sensi della Legge 24.12.1954, n. 1228 contro il provvedimento di cancellazione d’Ufficio dall’anagrafe della popolazione residente, adottato dall’Ufficiale di anagrafe del 
Comune di ______________________________________________________________________

PER I SEGUENTI MOTIVI: 

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                 (data)					                          (firma)

EVENTUALI ALLEGATI:

1) ____________________________________________________________________________ 
2) ____________________________________________________________________________
3) ____________________________________________________________________________
4) ____________________________________________________________________________
5) ____________________________________________________________________________	

N.B. –  La presente domanda (in bollo) può essere presentata direttamente alla Prefettura –       U.T.G. o spedita mediante lettera   raccomandata con avviso di ricevimento.