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D/Dª: ______________________________________________________ D.N.I./Pasaporte nº ____________________________

D/Dª: ______________________________________________________ D.N.I./Pasaporte nº ____________________________

DECLARAMOS bajo juramento no estar incapacitados para emitir el consentimiento necesario a efectos de llevar a cabo el acto de declaración objeto de inscripción.

Y para que conste expresamente en el expediente de su razón, firmamos y rubricamos la presente en Candeleda a_____________________________.

Fdo.: ________________________

Fdo.:_________________________

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