Al Signor 
Prefetto della Provincia di Ravenna 
Piazza del Popolo,26
48121 - Ravenna (RA)

RICORSO AI SENSI ART. 203 C.d.S. 

Riferimento verbale n. _________________________ del ______________________

notificato in data __________________ dalla Polizia Municipale Unione Romagna Faentina.

Il/la sottoscritto/a ______________________________________________________________
nato/a a _________________________________________(______)  il___________________
residente in ______________________________________________prov.________________ 
Via _________________________________________________________________n ______
recapito telefonico  _________________________ indirizzo e-mail ______________________

in qualità di  conducente  proprietario 

del veicolo targato ________________ tipo ______________________ colore ______________

presenta RICORSO per i seguenti motivi: 
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 
Si allega:

- verbale di contestazione;

- documentazione comprovante i motivi posti a suffragio del ricorso.
							
                                                                                                                   Firma
Faenza lì ______________________                         
                                                                                                    _________________________