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(Dichiarazione resa ai sensi del D.P.R. 28.12.2000, n. 445)
RIGHI da E8 a E12 codice 15
DICHIARAZIONE DELL’ADDETTO ALL’ASSISTENZA PERSONALE DI SOGGETTO NON AUTOSUFFICIENTE
Il/la sottoscritto/a ___________________________________ , codice fiscale ________________________________
consapevole delle conseguenze civili e penali derivanti da una falsa dichiarazione
DICHIARA
sotto la propria responsabilità di aver ricevuto nell’anno 2014 la somma di euro ___________________________ dal
Sig. /Sig.ra ________________________________________ codice fiscale _________________________________
per assistenza personale del sig./sig.ra stesso/a o del suo familiare non autosufficiente di seguito indicato:
Sig. /Sig.ra ________________________________________ codice fiscale __________________________________
Data _____/_____/ 2015
7
Ai fini della validità della presente autocertificazione si allega copia del documento di identità non scaduto.
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