CARTA D’IDENTITA’

COGNOME________________________________________________

NOME____________________________________________________

NATO IL__________________________________________________

A________________________________________________________

CITTADINANZA____________________________________________

RESIDENZA________________________________________________

VIA_______________________________________________________

STATO CIVILE_____________________________________________

PROFESSIONE______________________________________________

STATURA__________________________________________________

CAPELLI___________________________________________________

OCCHI_____________________________________________________

SEGNI PARTICOLARI_________________________________________

FIRMA DEL TITOLARE

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