AL TRIBUNALE ORDINARIO DI ASTI
N.R.G. V.G. _________________

Il sottoscritto_____________________________________________________________________
nato a ________________________________________________ il ________________________
codice fiscale ____________________________________________________________________
residente in _____________________via (corso)________________________________________
cittadino ________________________________ telefono_________________________________
e-mail___________________________________________________________________________
e la sottoscritta ___________________________________________________________________
nata a ________________________________________________ il ________________________
codice fiscale ____________________________________________________________________
residente in _____________________via (corso)________________________________________
cittadina ________________________________ telefono _________________________________
e-mail___________________________________________________________________________
in qualità di genitori di _____________________________________________________________
c h i e d o n o

la formazione  dell’atto di nascita del figlio in quanto_____________________________________
________________________________________________________________________________________________________________________________________________________________Si precisa che i dati del minore sono i seguenti:
Cognome:_______________________________________________________________________
Nome:__________________________________________________________________________
Nato/a a ______________________________________________il_________________________
Figlio/a di (indicare paternità):_____________________________________________________
Figlio/a di (indicare maternità):_____________________________________________________

Asti,  ___________                                                    Firma____________________________
                                                                                                                      (padre)

                                                                                               ____________________________
                                                                                                                     (madre)