RICHIESTA

INSERZIONE MESSAGGIO SU TABELLONE LUMINOSO

La/Il sottoscritta/o ________________________________________________________

nata/o a ______________________________________ il _______________________________________

residente a ____________________________ in Via ____________________ n. ____________________

PER CONTO DI _________________________________________________________________________

TESTO  MESSAGGIO

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per il periodo:

dal _____________

al   _____________

Firma

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________________ li _____________