Mod.N.4/ Uff.Ricorsi Anagrafici   				    		 Protocollo N._____________________
Area II                    			      ANAGRAFE  		              Ricevuta il ______________________
Tel.011/5589 611			                                  	   	              Da completare dall'ufficio 
Tel.011/5589492          		        	                                            		 À compléter par l'administration						          			                          To  be completed by the administration

Bollo
€ 	14,62	
                                   Modello di domanda per ricorso anagrafico

						          AL PREFETTO dell’ U.T.G. PREFETTURA di TORINO						          Area II -  Ufficio Ricorsi anagrafici
          	                    Piazza Castello, 205   -     10124 TORINO

1. __________________________________________ 2. DATA DI NASCITA    __ /___/_____
    COGNOME e NOME-Nom et Prénome-Surname and  Forename                    Date de naissance  - Date of Birth 
3. ____________________________________________________                  (_____________)
    LUOGO DI NASCITA - Lieux de naissance- Place of birth		                     			       PROVINCIA
4. _________________________________________ 5. _________________________
    STATO - État - State 					                                        CITTADINANZA- Nazionalité - Citizenship
6. __________________________________________________               (__________)
    INDIRIZZO residenza- Adresse  - Address 	                      			                                         PROVINCIA	
7. ________________   8.______________________  9. _________________________
    C.A.P.-Code postal - Postcode                      TELEFONO 			                      E – MAIL

Compilare solo se diverso dalla residenza :
Rédigez seulement si est different de la résidence -  Fill the blank only if it is different from residence: 

10. ____________________________________________________________________________              (__________)     
     INDIRIZZO DOMICILIO Adresse où vous habitez - Home Address      CITTA' Ville - Town                            PROVINCIA	
11. _______________________    12. _________________________________________________________	                                                                  C.A.P.Code postal - Postcode                PRESSO – Chez - At				               	                                  
					
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: 

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________ 

___________________________________________________________________________________________

___________________________________________________________________________________________

Mod .4 /Uff.ricorsi anagrafici (segue)

Mod. 4 /Uff.ricorsi anagrafici (segue)

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

				

_________________________			___________________________________

                                 (DATA -Date)						         (FIRMA - SIGNATURE)

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.