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ATTACHMENT

RESIDENCE DECLARATION

Residence declaration coming from another municipality. Indicate the municipality of

origin:
ANCONA
Declaration of residence with origin from abroad. Indicate the foreign state of
provenance

Declaration of residence of Italian citizens registered with AIRE (Register of Italians abroad)
residents abroad) with origin from abroad. Indicate the foreign State of
origin and the municipality of AIRE registration

Declaration of change of residence within the same municipality

Registration for another reason

(specify the reason ………………………………………………………………………)

The undersigned

1) Cognome* ROSSI
Nome* LUIGI Data di nascita *10/04/1948
Place of birth*MILAN Sex*M Marital Status ** MARRIED
Italian Citizenship Codice Fiscale*RSSLGU48D10F205E
Position in the profession if employed: **
Entrepreneur Leader Worker Worker
Freelancer Clerk x2 in own □3 and similar □4
Co-adjuvant □5
Non-professional condition: **
Casilinga□1 Studente□2 Disoccupato/in cerca di prima occupazione□3
Pensioner / Retired from work □4 Other non-professional condition □5
Degree title: **
Nessun titolo/Lic. Elementare □1 Lic. Media□2 Diplomax3 Laurea triennale□4
Laurea□5 Dottorato □6
Type B license
Number*** MI 234567S
Data di rilascio*** 30/04/1968
Issuing body *** PREFECTURE OF MILAN Province of ***MI
License plates of vehicles registered in Italy as owner/co-owner,
usufructuary/Tenant***
Vehicles*** AF 259 TP
Trailers***
Motor vehicles***
Mopeds

Aware of the criminal liabilities for false statements pursuant to the

Articles 75 and 76 of DPR 445/2000 which provide for the loss of benefits and the obligation to
report to the competent authority.

DECLARE

□ To have transferred the permanent residence to the following address:

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ATTACHMENT

Municipality* MILAN Province*MI

Via/Square * SQUARE SCALA Civic number* 54
Scala F Piano 2 Internal 34

The family members listed below have also moved to the residence located at the new address.
:
specifications

2) Cognome* VERDI
Nome* MARIA Data di nascita * 02/05/1953
Luogo di nascita*MILANO Sex*F Marital Status ** MARRIED
Italian Citizenship Tax Code* VRDMLR53E42F205I
Relationship to the applicant * SPOUSE
Position in the profession if occupied: **
Entrepreneur Leader Worker Worker
Freelancer Employee in its own □3 and assimilated□4
Adjuvant 5
Non-professional condition: **
CasilingaX1 Studente□2 Disoccupato/in cerca di prima occupazione□3
Retired / Withdrawn from work□4 Other non-professional condition□5
Educational qualification: **
No title/Elementary license□1 Middle school license□2 High school diploma X3 Bachelor's degree
Bachelor's degree□5Doctorate□6

License B
Number***MI 87654 P
Data di rilascio*** 02/06/1973
Issuing Authority *** PREFECTURE OF MILAN Province of *** MI
License plates of vehicles registered in Italy as owner/co-owner,
usufructuary/Tenant***
Vehicles***
Trailers***
Motor vehicles***
Mopeds

3) Cognome*
Nome* Date of birth *
Place of birth* Gender* Marital status
Citizenship* Codice Fiscale*
Relationship to the applicant *
Position in the profession if employed: **
Entrepreneur Leader Worker Worker
Freelancer Employee in property and assimilated
Adjuvant 5
Non-professional condition: **
["Casilinga","Student","Unemployed/looking for first job"]
{"condition1":"Retired / Withdrawn from work","condition2":"Other non-professional condition"}

Titolo di studio: **
No title / Elementary License □1 Middle School License □2 Diploma □3 Bachelor's degree □4
Degree□5Doctorate□6
License type***
Number***
Release date***
Issuing body*** Province of***
License plates of vehicles registered in Italy as owner/co-owner,
usufructuary/Tenant***
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ATTACHMENT

Vehicles
Trailers
Motor vehicles***
Scooters

Surname*
Nome* Date of birth *
Luogo di nascita* Sex* Marital status
Citizenship* Tax Code*
Relationship to the applicant *
Position in the profession if occupied: **
Entrepreneur Leader Worker Worker
Freelancer Employee in own and related
Adjuvant 5
Non-professional condition: **
Casilinga: Student: Unemployed/looking for first job
Pensioned / Retired from work□4 Other non-professional condition□5
Degree title: **
Nessun titolo/Lic. elementare□1 Lic. Media□2 Diploma □3 Bachelor's degree
Laurea□5 Dottorato □6
Type license ***
Number***
Release date***
Issuing body*** Province of***
License plates of vehicles registered in Italy as owner/co-owner,
usufructuary/Tenant***
Motor vehicles***
Trailers***
Motor vehicles***
Mopeds

XThose residing at the new address are already registered as follows (it is sufficient
specify the details of a family member:

Last name * ROSSI Nome * MARCO

Place *MILAN Data di nascita * 25/05/1976

There are no marital relations. The following constraint exists regarding the
kinship, affinity, adoption, guardianship or union component of the family already
affective bonds with the components of resident:
the PARENTS
family already residing.

The following documents are attached:

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ATTACHMENT

All communications regarding this declaration must be sent to the following

contact details

Municipality of MILAN Province MI

Via/Piazza [Link] SCALA Civic number 54
Phone 02/1234567 Mobile 34000000
Fax 02/ 98765432 e-mail/PEC

Data 09/05/2012 Applicant's signature

… Luigi Rossi ...

Signature of other adult family members

Surname and name: Maria Verdi

Last name and first name ...

Mode of presentation

This form must be filled out, signed, and submitted to the civil registry office.
from the municipality where the applicant intends to establish their residence, or sent to the addresses
published on the official website of the municipality by registered mail, by fax, or electronically.
This last opportunity is allowed under one of the following conditions:
a) that the declaration is signed with a digital signature;
b) that the author is identified by the computer system using the identity card
electronics, the national services card, or otherwise with tools that allow
the identification of the subject who makes the declaration;
c) that the declaration is transmitted through the certified email box of
applicant.
that the copy of the declaration bearing the applicant's handwritten signature is obtained
scanned and sent via simple email.
A copy of the applicant's identity document and of the must be attached to the declaration.
people who move their residence together with the applicant who, if they are adults, must
sign the form.
The citizen coming from a foreign State, for the purpose of registration in the registry of the relationship
of kinship with other family members, must attach the relevant documentation, in
Rule with the provisions regarding the translation and legalization of documents.
The citizen of a state not belonging to the European Union must attach the documentation.
indicated in attachment A).
The citizen of a state belonging to the European Union must attach the indicated documentation.
in annex B).

The applicant must fill out the form for themselves and for the individuals over whom they exercise guardianship.
or the guardianship.

_______________________________

* Mandatory data. Failing to fill in the fields related to mandatory data will result in the application not being accepted.
Statistical interest data.
Data of interest from the Ministry of Infrastructure and Transport - Department for Land Transport (art.116, paragraph 11, of
. C.d.S.)