Modulo di autocertificazione
Modulo di autocertificazione
Modulo di autocertificazione
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DICHIARAZIONE SOSTITUTIVA DI CERTIFICAZIONE<br />
(Art. 46, D.P.R. 28.12.2000 n. 445)<br />
Io sottoscritto/a<br />
nato a<br />
il residente a prov.<br />
In<strong>di</strong>rizzo n. c.a.p.<br />
telefono fisso cellulare e-mail<br />
iscritto per l’a.a.<br />
al seguente corso <strong>di</strong> stu<strong>di</strong>o<br />
ai sensi dell’art. 46 del D.P.R. 28 <strong>di</strong>cembre 2000, n. 445 e consapevole che, ai sensi dell’art.76 dello stesso D.P.R.<br />
445/2000 “chiunque rilascia <strong>di</strong>chiarazioni mendaci, forma atti falsi o ne fa uso nei casi previsti dal presente Testo<br />
Unico è punito dal co<strong>di</strong>ce penale e dalle leggi speciali in materia” ed incorre, altresì, nella decadenza dai benefici <strong>di</strong><br />
cui all’art. 75<br />
DICHIARO SOTTO LA MIA RESPONSABILITA’ QUANTO SEGUE:<br />
(Testo dell’<strong>autocertificazione</strong>)<br />
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Dichiarazione sostitutiva <strong>di</strong> certificazione – pag. 1 <strong>di</strong> 2
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Data, / / Firma<br />
Esente da autentica della firma ai sensi dell’art. 46 D.P.R. 445 28/12/2000; esente da imposta <strong>di</strong> bollo ai sensi dell’art.<br />
37, comma 1 e 2D.P.R. 445 28/12/2000.<br />
AVVERTENZA: le amministrazioni procedenti sono tenute ad effettuare idonei controlli, anche a campione, e in tutti i<br />
casi in cui sorgono fondati dubbi sulla veri<strong>di</strong>cità delle <strong>di</strong>chiarazioni sostitutive stesse.<br />
Dichiarazione sostitutiva <strong>di</strong> certificazione – pag. 2 <strong>di</strong> 2
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