JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Modulo Autolettura Contatore Acqua
( Dichiarazione sostitutiva dell'atto di notorietà - D.P.R 28/12/2000, n° 445, art. 47)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Cognome e Nome
*
Your answer
Codice Fiscale
*
Your answer
Indirizzo di residenza
*
Your answer
Telefono
Your answer
Matricola Contatore
*
Your answer
Ubicazione utenza
*
Your answer
Uso
*
Domestico
Non Domestico
Irriguo
Allevamento Animali
Stato del contatore
Non funzionante
Sigillo non presente
Da sostituire
Illeggibile
Clear selection
Lettura
Your answer
Data
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report