Al Difensore civico
del Comune di CELENZA SUL TRIGNO  

Oggetto:  Richiesta di intervento del Difensore Civico.

Il sottoscritto _________________________________________________________________, nato a ________________________________________________ il ___________________________, residente in ______________________________, via ______________________________________,  tel. ________________ e-mail _________________________________________________________, 
C h i e d e
al Difensore Civico del Comune di poter prendere in esame la problematica che, in sintesi, è sotto descritta, e di ricevere in merito opportuni ragguagli:
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Data _____________________                                       ________________________________
      								       Firma