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\f0\fs28\cf17\insrsid69278 \tab }{\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \f0\fs28\cf17\insrsid15870096\charrsid3869855 Al Sig. 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\f0\fs22\cf17\insrsid15556760 Io}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 sottoscritt___ _______}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ______}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15556760 _____}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 _____________________________________________ nat___ a _____________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 _________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 _______________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ________________ il _________________________ residente nel Comune di ____________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ______}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ______________________________________ i}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 n via ________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 __________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 __}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ______________________________ n. ________ telefono n. ___________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ____________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15556760 __}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ____ essendo effett}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15556760 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 da: \par }\pard\plain \ltrpar\s15\qj \fi-397\li397\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin397\itap0\pararsid15539876 \rtlch\fcs1 \af311\afs24\alang1025 \ltrch\fcs0 \f311\fs24\cf1\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 { \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15539876 [_]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid15870096\charrsid3869855 }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid15539876 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 gravissima infermit\'e0, tale che l'allontanamento dall'abitazione in cui dimor}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid4729820 o}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 risulta impossibile anche con l'ausilio dei servizi organizzati dal Comune per gli elettori disabili}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid15870096\charrsid3869855 ; \par }\pard \ltrpar\s15\qc \fi-284\li284\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin284\itap0\pararsid3869855 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ovver}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid15870096\charrsid3869855 o \par }\pard \ltrpar\s15\qj \fi-397\li397\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin397\itap0\pararsid15539876 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15539876 [_]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid3869855 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 da grave infermit\'e0 tale da impedire l'allontanamento dall'abitazi}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 one in cui dimoro a causa della }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 dipendenza continuativa e vitale da apparecchiature elettromedicali }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid15870096\charrsid3869855 \par }\pard \ltrpar\s15\qc \li0\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin0\itap0\pararsid3869855 {\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0 \b\f0\fs22\cf17\insrsid15870096\charrsid3869855 D I C H I A R O \par }\pard \ltrpar\s15\qj \li0\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin0\itap0\pararsid3869855 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 la volont\'e0 di esprimere il voto per la consultazion}{ \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 e elettorale del _______}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 _____________ presso l'abitazione sita in via ________________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ______________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 ________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 _________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ____ n. ________ del Comune di _________________________________________________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid12707 ___}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 _________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 ________}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ________. \par Allo scopo allego: \par }\pard \ltrpar\s15\qj \fi-397\li397\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin397\itap0\pararsid15539876 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15539876 [_]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid4275772 \tab copia fotostatica della tessera elettorale; \par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15539876 [_]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid11420002 un certificato medico della competente Autorit \'e0 Sanitaria Locale}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 attestante l'esistenza delle condizioni di infermit\'e0 di cui al comma 1 dell'art. 1 della Legge n. 46/2009, con prognosi di 60 giorni decorrenti dalla data di rilascio}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\super\insrsid15870096\charrsid11420002 (2)}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 . \par }\pard \ltrpar\s15\qc \fi-284\li284\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin284\itap0\pararsid3869855 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 ovvero \par }\pard \ltrpar\s15\qj \fi-397\li397\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin397\itap0\pararsid15539876 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15539876 [_]}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid3869855 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 certificato medico }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid10383032 della competente Autorit\'e0 Sanitaria Locale}{ \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 attestante la condizione di dipendenza continuativa e vitale da apparecchiature elettromedicali}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\super\insrsid15870096\charrsid4275772 (2)}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 . \par }\pard\plain \ltrpar\s17\qj \li0\ri0\sl360\slmult1\nowidctlpar\tx4111\wrapdefault\faauto\rin0\lin0\itap0\pararsid3869855 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f311\fs24\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 Resto in attesa di ricevere la prescritta attestazione che da diritto all'esercizio di voto a domicilio. \par }\pard\plain \ltrpar\s20\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid15870096 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f311\fs24\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 \par }\pard\plain \ltrpar\s15\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid15870096 \rtlch\fcs1 \af311\afs24\alang1025 \ltrch\fcs0 \f311\fs24\cf1\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid15870096\charrsid3869855 \par }\pard\plain \ltrpar\s20\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid15870096 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f311\fs24\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f0\fs22\cf17\insrsid15870096\charrsid3869855 Data }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\cf17\insrsid15870096\charrsid3869855 __________}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\cf17\insrsid3869855 ____}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\cf17\insrsid15870096\charrsid3869855 ____________ }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid15870096\charrsid3869855 \tab \tab \tab \tab }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid3869855 \par }\pard \ltrpar\s20\qr \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid3869855 {\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid3869855 \par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\cf17\insrsid15870096\charrsid3869855 ___________}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\cf17\insrsid3869855 ____}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\cf17\insrsid15870096\charrsid3869855 _______________________ \par }\pard \ltrpar\s20\qj \li5760\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin5760\itap0\pararsid3869855 {\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \b\f0\fs22\cf17\insrsid12707 }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \b\f0\fs22\cf17\insrsid3869855\charrsid3869855 Firma}{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \b\f0\fs22\cf17\insrsid15870096\charrsid3869855 \par }\pard\plain \ltrpar\s15\qj \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid15870096 \rtlch\fcs1 \af311\afs24\alang1025 \ltrch\fcs0 \f311\fs24\cf1\lang1040\langfe1040\cgrid\langnp1040\langfenp1040 {\rtlch\fcs1 \af0\afs14 \ltrch\fcs0 \f0\fs14\cf17\insrsid15870096\charrsid3869855 \par \par \par }{\rtlch\fcs1 \af0\afs14 \ltrch\fcs0 \f0\fs14\cf17\insrsid15870096 \par }{\rtlch\fcs1 \af0\afs14 \ltrch\fcs0 \f0\fs14\cf17\insrsid12707\charrsid3869855 \par }\pard \ltrpar\s15\qj \fi-284\li284\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin284\itap0\pararsid3869855 {\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid15870096\charrsid3869855 (1) }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid3869855 \tab }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid15870096\charrsid3869855 La domanda va presentata, tra il 40\'b0 ed il 20\'b0 giorno antecedente la data della votazione, al Sindaco del Comune nelle cui liste elettorali si \'e8 iscritti. \par (2) }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid3869855 \tab }{\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \f0\fs16\cf17\insrsid15870096\charrsid3869855 Il certificato non deve essere in data anteriore al 45\'b0 giorno antecedente la votazione. \par }}