MOD. APR 010 – Rev.

8
ANNEX 1
RESIDENCE DECLARATION

Dichiarazione di residenza con provenienza da altro comune. Indicare il comune di

provenance
the address
Residence declaration with origin from abroad. Indicate the Municipality and the State
country of origin
……………………………………………………………………………………………………..
possible Italian municipality and previous residence address
……………………………………………………………………………………………………..
Declaration of residence of Italian citizens registered with AIRE (Registry of Italians residing abroad)
from abroad) with origins from abroad. Indicate the Municipality and the foreign State of origin and the
Italian municipality of AIRE registration ………………………………………….
…………………………………………………………………….
Declaration of change of residence within the same municipality, with
previous address in via................................................

Registration for another reason (please specify the reason ......................................………………....)

THE UNDERSIGNED
Last Name*
Nome* Date of birth *
Place of birth* Sex* Marital status *
(married or widowed): Name/surname/date and place of birth (married or widowed) Date and place of marriage*
spouse

Citizenship* Tax Code*

Nome e Cognome del padre* First and Last Name of the mother*

Position in the profession if employed: **

Entrepreneur Leader Worker Worker
Freelancer 1 Employee 2 in one's own 3 and the assimilated 4 Adjuvant 5

Specify occupation.
Non-professional condition: **
Housewife 1 Student 2 Unemployed/looking for first job 3
Retired / Withdrawn from work 4 Another non-professional condition 5
Degree title: **
No title/Elementary License 1 Lic. Media 2 Diploma 3 Bachelor's degree 4
Degree 5 Doctorate 6
Type license***
Number***
Release date***
Issuing body*** Province of***
License plates of vehicles registered in Italy as owner/co-owner, legal usufructuary/tenant***
Vehicles * * *
Trailers***
Motor vehicles
Mopeds***

Aware of the criminal responsibilities for false statements pursuant to Articles 75 and 76 of the DPR
445/2000 which establishes the forfeiture of benefits and the obligation to report to the competent authority.
DECLARE

To have transferred the usual residence to the following address:

Municipality* Province*
Street/Square * Civic number*
Internal Scala* Piano N.U.I *
(N° appartamento)
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That family members have also moved to the residence at the new address as follows
specifications:
Last name*
Nome* Date of birth *
Place of birth* Sex* Marital status *
(married or widowed): Name/surname/date and place (married or widowed) Date and place of marriage*
spouse's birth

Citizenship* Tax Code*

Father's Name and Surname* Mother's First and Last Name*
Relationship to the applicant *
Position in the profession if employed: **
Entrepreneur Leader Worker Worker
Freelancer 1 Employee 2 in one's own right 3 and the assimilated 4 Adjuvant 5

Specify occupation.
Non-professional condition: **
Housewife 1 Student 2 Unemployed/looking for first employment 3
Retired / Retired from work 4 Another non-professional condition 5
Degree Title: **
No title/Elementary License 1 Media Lic. 2 Diploma 3 Bachelor's degree 4
Degree 5 Doctorate 6
Type license***
Number***
Release date***
Issuing authority*** Province of***
Vehicle registration plates registered in Italy as owner/co-owner, usufructuary/tenant.
Vehicles ***
Trailers***
Motor vehicles***
Scooters***

3)Cognome*
Name* Date of birth *
Place of birth* Sex* Marital status *
(married or widowed): First name/last name/date and place (married or widowed) Date and place of marriage*
spouse's birth*

Citizenship Tax Code*

Father's First and Last Name* Mother's First and Last Name*
Relationship to the applicant *
Position in the profession if occupied: **
Entrepreneur Leader Worker Worker
Freelancer 1 Employee 2 in one's own 3 and assimilated 4 Adjuvant 5

Specify occupation.
Non-professional condition: **
Housewife 1 Student 2 Unemployed/in search of first job 3
Retired / Retired from work 4 Other non-professional condition 5

Degree title: **
No title/Elementary License 1 Lic. Media 2 Diploma 3 Bachelor's degree 4
Degree 5 PhD 6
Type of license***
Number***
Release date***
Issuing authority Province of***
License plates of vehicles registered in Italy as owner/co-owner, usufructuary/lessee.
Vehicles * * *
Trailers***
Motor vehicles
Mopeds
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ATTACHMENT 1
Surname*
Name* Date of birth *
Place of birth* Sex* Marital status *
(married or widowed): Name/surname/date and place (married or widowed) Date and place of marriage*
spouse's birth

Citizenship* Tax Code*

First and Last Name of the Father* Mother's Name and Surname*
Relationship to the applicant *
Position in the profession if employed: **
Entrepreneur Leader Worker Worker
Freelancer 1 Employee 2 in one's own 3 and the assimilated 4 Adjuvant 5

Specify occupation.
Non-professional condition: **
Housewife 1 Student 2 Unemployed/looking for first employment 3
Retired / Withdrawn from work 4 Another non-professional condition 5
Educational qualification: **
No title/Elementary license 1 Lic. Media 2 Diploma 3 Bachelor's degree 4
Degree 5 Doctorate 6
License type***
Number***
Release date***
Issuing body Province of***
License plates of vehicles registered in Italy as owner/co-owner, usufructuary/lessee* * *
Vehicles
Trailers***
Motor vehicles***
Mopeds

That at the residence located at the new address, the following persons are already registered (it is
it is sufficient to specify the general information of a family member):

Cognome* Name *
Place * Date of birth *
Choose one of the two options below:
There are no marriage relationships, The following constraint exists regarding the
kinship, affinity, adoption, guardianship or ties sindicate component of the family already
affectionate with family members already residente: __________________________
resident __________________________

to occupy the dwelling legitimately based on the title described below, aware
Hey, pursuant to Article 5 of Decree Law No. 47 of March 28, 2014 (converted into Law No. 80 of May 23, 2014), in
in case of false declaration, the registration will be null, by express provision of
law, effective from the date of the declaration itself:
(cross out and complete one of the following alternatives)

1To be the owner (or co-owner)

property identified by the following cadastral details: Category A/____
Sezione ______ ; Foglio _______ ; Particella o mappale _______ ; Subalterno ______

To be the holder of the rental agreement duly registered with

The Revenue Agency of ________________; on the date _________; at no. ___________

3D to be the holder of a lease contract related to a property of Building Housing

Public Residential (ATC - Territorial Agency for Housing, formerly IACP, Institute)
Housing for the Unemployed; attach a copy of the contract or the delivery report
of the property)
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I must be a borrower with a free loan agreement duly
registered with the Revenue Agency of ___________; on the date _______; at no. ____

I am a usufructuary, by virtue of the following constitutive title:

provide useful data to allow verification by the Registry Office

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6Di legally occupy the residence based on the title described below (e.g.
lease agreement in the process of registration within the first 30 days of signing;
cohabitation with another title holder: in this case insert the relevant data; other)
provide useful data to allow verification by the Registry Office

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

The following documents are attached:

___________________________
___________________________

All communications regarding this declaration must be sent to

following contacts:
Municipality Province
Street/Square Civic Number
Telephone Mobile
Fax e-mail/PEC
Data ... Applicant's signature

…………………………………….…

Presentation Mode
This form must be filled out, signed, and submitted to the registry office of the municipality where the applicant
intends to establish his residence, or sent to the addresses published on the institutional website of the municipality by registered mail,
by fax or by electronic means.
This last chance is granted under one of the following conditions:
a) that the declaration is signed with a digital signature;
b) that the author is identified by the information system using the electronic identity card, the national card of
services, or in any case with tools that allow the identification of the person making the declaration;
c) that the declaration is transmitted through the certified email box of the applicant.
d) that the copy of the declaration bearing the handwritten signature of the applicant is acquired via scanner and transmitted
via simple email.
A copy of the identity document of the applicant and the people transferring the property must be attached to the declaration.
residence together with the applicant.
The citizen coming from a foreign state, for the purposes of registration in the civil registry of the family relationship with other members
of the family, must attach the relevant documentation, compliant with the provisions regarding translation and legalization
of the documents.
The non-European Union state citizen must attach the documentation indicated in annex A.
The citizen of a State belonging to the European Union must attach the documentation indicated in annex B).
The applicant must fill out the form for themselves and for the individuals for whom they exercise authority or guardianship. (each component
It can also make statements regarding the changes in the positions of other family members.
____________________________________

*Required fields: Failure to fill in the fields related to

Mandatory data results in the non-acceptance of the application.
* * Statistical interest data.
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*** Data of interest from the Ministry of Infrastructure and Transport - Department for Land Transport, essential for obtaining the stickers of
update residence on the vehicle registration document and update the driving license information in the national registry of driving license holders (art. 116, paragraph 13, of
Highway Code